final

Question 1

In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduces the number of its nursing managers. Within a year the number of adverse events on the units has doubled. This may be attributable to:
a. The overload of work for staff nurses.
b. Inability of staff at the bedside to make good choices.
c. A change in reporting systems.
d. Fewer clinical leaders and advocates for necessary resources.

Answer 1

d

Question 2

Traditional approaches to ensuring patient safety have focused on:
a. Assigning blame.
b. Finding solutions to systems issues.
c. Instituting best practices in response to errors.
d. Hiding errors from potential litigation.

Answer 2

a

Question 3

What is the primary purpose of nursing standards?
a. To inform performance appraisals at the unit level.
b. To identify the desired level of performance.
c. To inform the courts in relation to negligence and malpractice cases.
d. To educate other health care professionals about the role of the nurse.

Answer 3

b

Question 4

During review of back injuries, it is determined that mechanical lifts and transfer belts are not being properly used. In addressing this concern, the unit manager:
a. Meets individually with nurses, who are observed using the lifts incorrectly, to
review the correct procedure.
b. Consults with the staff about the review to determine how best to proceed.
c. Blames the system for inadequate funding for resources.
d. Reviews the system of reporting adverse events to ensure that appropriate
reporting is occurring.

Answer 4

b

Question 5

The nursing manager changed the current model of implementing nursing rounds of patients each day at 1200 hours to implementing interdisciplinary rounds of patients at 1000 hours. This change reflects:
a. A patient-centred care initiative.
b. Delegation of responsibility from nursing to other health care professionals.
c. Lack of consultation among the nursing staff.
d. An inappropriate time to complete patient rounds and will probably not work.

Answer 5

a

Question 6

Which of the following represents an activity that supports patient-centred care?
a. Posting of visiting hours on the entrance way to each hospital unit
b. Regular staff surveys to monitor organizational satisfaction
c. Reserved parking spots at the main hospital entrance for physicians
d. Creating e-health stations on each inpatient unit

Answer 6

d

Question 7

After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at a Canadian university develops:
a. A nursing program that emphasizes the development of a strong disciplinary
identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care professionals to develop software for reporting of
adverse events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners
that emphasizes collaborative learning teams.

Answer 7

d

Question 8

In designing a high-quality, safe health care environment, the primary emphasis needs to be on:
a. Evidence-informed practice.
b. Informatics.
c. Staffing.
d. The patient.

Answer 8

d

Question 9

As a patient care advocate, you regularly coach patients in how to stay safe in health care by educating them about:
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
c. Washing hands frequently while in a health care environment and using a hand sanitizer.
d. Following closely the directions and orders of health care providers.

Answer 9

a

Question 10

What is the focus in a culture of safety?
a. Employee safety.
b. Investigating who is making health care errors.
c. Effective systems and team work
d. Professional nursing standards and ethical codes

Answer 10

c

Question 11

Which attribute is a common feature of a culture of safety?
a. Voluntary reporting of incidents.
b. Organization behaviour.
c. Individual-focused policies.
d. A nonpunitive approach to adverse event reporting and analysis.

Answer 11

d

Question 12

Which of the following depicts a nursing-sensitive outcome?
a. Programming that increases individual nurse competency to offer smoking
cessation programs.
b. Implementation of informatics at the patient’s bedside.
c. Staff–manager conferences to review reporting of adverse events.
d. Patient council meetings to review food, recreation, and nurse–patient relations.

Answer 12

a

Question 13

Having team “huddles” each day on the nursing unit is a reflection of:
a. Nurses’ need to socialize.
b. Creating a culture of safety.
c. Ensuring distribution of equal workloads.
d. The manager`s need to talk with staff nurses on a daily basis.

Answer 13

b

Question 14

Approximately what percentage of Canadian hospital admissions can be expected to include an adverse event?
a. 5
b. 7.5 c. 10 d. 12.5

Answer 14

b

Question 15

Having access to information, evidence, and research is an important driver for quality and;
a. Nurse safety.
b. Patient safety.
c. Organizational policy development.
d. Patient-centred care.

Answer 15

b

Question 16

Which of the following represents a potential use of nurse-sensitive outcomes?
a. Informing best practices.
b. Accountability for nursing behaviours.
c. Performance appraisals.
d. Maintaining the status quo.

Answer 16

a

Question 17

Which of the following is a CPSI safety competency?
a. Practise patient-centred care.
b. Optimize human and environmental factors.
c. Analyze nurse-sensitive outcomes.
d. Assess nurse staffing and skill mix.

Answer 17

b

Question 18

On the basis of a review of increased falls with injury and increased use of restraint during evening hours, you as the unit manager are most likely to:
a. Review daytime and evening staffing mixes.
b. Schedule continuing education for all staff members.
c. Review the safety of ambulation devices.
d. Continue your current practices and procedures.

Answer 18

a

Question 19

As the nurse was about to administer an oral mediation, the patient states, “That pill is the wrong colour.” The nurse goes back to the medication administration area to check the medication and realizes that it is indeed the wrong pill. Does this situation require the completion of an adverse event report?
a. No; there was no actual error.
b. No; it was the patient who stopped an error from occurring.
c. Yes; an error almost occurred, and close calls are to be reported.
d. It is up to the nurse to decide whether to complete an adverse event report.

Answer 19

c

Question 20

Which of the following is the CPSIs flagship program?
a. Patients Are First.
b. Safer Healthcare Now.
c. Safe Healthcare for All.
d. Patient Safety Culture Improvement.

Answer 20

b

Question 21

Organizational changes that promote systems thinking, collective accountability, and team-based care are examples of:
a. Activities that promote patient-centred care.
b. Accreditation standards that hospitals must meet.
c. Outdated practices that are not grounded in current evidence.
d. Quality improvement initiatives.

Answer 21

a

Question 22

Robert, an experienced nurse, discovered a medication order was incorrectly translated. The pharmacist filled the medication and sent it to be administered to the patient. When the medication arrived Robert questioned the dose and consulted with the nurse manager. The order was clarified with the physician and changed to the correct dose. When reviewing the incident the nurse manager determined the near miss was related to which of the following?
a. Individual error.
b. System error.
c. An individual and system error.
d. Attributed to increased workload.

Answer 22

c

Question 23

Gail, a senior nursing student, consults with her preceptor about a patient who has refused his medication. When speaking with the patient he expresses that he does not believe the medication is helping with his pain level. From a nursing sensitive outcome, which outcomes are addressed in this situation? (Select all that apply.)
a. Quality of nursing care.
b. Symptom management.
c. Patient satisfaction.
d. Functional status.

Answer 23

b,c

Question 24

Gathering information on patient outcomes leads to which of the following? (Select all that apply.)
a. Evaluating different approaches to care.
b. Increasing quality of nursing care.
c. Decreasing nursing autonomy.
d. Having a positive impact at the individual, unit, and organization levels.

Answer 24

a,b,d

Question 25

. Rose a new nursing graduate chose hospital X for its culture of safety. Which of the following attributes contribute to this culture of safety? (Select all that apply.)
a. Trusting and open communication
b. Organizational learning
c. A system rather that an individual approach to safety
d. Teamwork

Answer 25

a,b,c,d

Question 26

Which of the following contribute to improved patient safety? (Select all that apply.)
a. Leadership capability.
b. Patient involvement in own care.
c. Data collection.
d. Increased staff mix.

Answer 26

a,b,c

Question 27

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee’s good qualities and that they give positive direction for professional growth. This belief is an example of:
a. Justice.
b. Fidelity.
c. Beneficence.
d. Nonmaleficence.

Answer 27

d

Question 28

Normative ethics is concerned with the:
a. Broader theory and meaning of morality.
b. Foundation and scope of moral values, words, and practice.
c. Standards that most people use to guide their behaviours.

Answer 28

c

Question 29

A patient refuses a simple procedure that you believe is in the patient’s best interest. The two ethical principles that are directly in conflict in such a situation are:
a. Fidelity and justice.
b. Veracity and fidelity.
c. Autonomy and beneficence.
d. Paternalism and respect for others.

Answer 29

c

Question 30

Three gravely ill patients are candidates for the only available bed in the intensive care unit. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles?
a. Beneficence.
b. Autonomy.
c. Veracity.
d. Nonmaleficence.

Answer 30

a

Question 31

Which ethical principle is primarily involved in informed consent? a. Veracity.
b. Autonomy.
c. Beneficence.
d. Nonmaleficence.

Answer 31

b

Question 32

Which of the following is a key area of ethical nursing practice?
a. Nursing process.
b. Therapeutic relationship.
c. Decision-making model.
d. Embodied knowledge.

Answer 32

b

Question 33

Which question reflects the essence of relational ethics?
a. “What can I do to maintain my professional practice?”
b. “What should I do for others?”
c. “What techniques can I use to empower my colleagues?”
d. “What ethical decision-making model will work best for me?”

Answer 33

b

Question 34

The nurse manager organizes interprofessional team meetings on a weekly basis. This action is demonstrating which aspect of relational ethics?
a. Embodied knowledge.
b. Interdependent environment.
c. Engaged interactions.
d. Mutual respect.

Answer 34

d

Question 35

According to relational ethics, what is critical in the development and maintenance of the roles and actions of the nurse manager?
a. Time management skills.
b. Professional relationships.
c. Comprehension of the Quebec Nurses Association’s Code of Ethics for nursing.

Answer 35

b

Question 36

Which of the following is a criticism of the principle of autonomy?
a. It is not culturally sensitive.
b. It can lead to focus on the needs of one person at the expense of the needs of
others.
c. It is not applicable with entire groups.
d. It can be viewed as advancing professional directives rather than patient desires.

Answer 36

b

Question 37

Autonomy is best promoted through which of the following, in taking a relational approach to autonomy?
a. Specific roles within the relationship.
b. Social change.
c. Protecting an individual’s freedom of choice.
d. The necessity of treating everyone fairly.

Answer 37

b

Question 38

Sue, a staff nurse, consistently arrives 15 minute late for her shift, and the nurse manager has talked to her about it several times. Sue does not take the comments seriously because there are two other nurses who also arrive late all the time, and the unit manager does not reprimand them. In this situation, the nurse manager is violating the ethical principle of: a. Beneficence.
b. Nonmaleficence. c. Justice.
d. Autonomy.

Answer 38

c

Question 39

Which element of the Code of Ethics of the International Council of Nurses is reflected in the following statement: “The nurse manager sets policies and procedures to guide ethical nursing practice?”
a. People.
b. Practice.
c. Profession. d. Coworkers.

Answer 39

c

Question 40

Which element of the Code of Ethics of the International Council of Nurses is reflected when the nurse manager establishes a system for performance appraisals?
a. People.
b. Practice.
c. Profession. d. Coworkers.

Answer 40

b

Question 41

What is reflected when a nurse feels a lack of clarity or is unable to know even what the moral problem is, whereas at the same time feeling uneasy or uncomfortable about the situation?
a. Moral distress.
b. Moral uncertainty.
c. Ethical dilemma.
d. Ethical distress.

Answer 41

b

Question 42

A patient’s husband asks to speak with the nursing manager. He is visibly upset and tells the nursing manager that while at the corner store, he overheard two nurses discussing his wife’s health issues and is certain that others around him also heard the discussion. This is an example of:
a. Ethical distress.
b. An ethical violation.
c. Moral inappropriateness.
d. An ethical dilemma.

Answer 42

b

Question 43

Sally, a fourth year nursing student, was assigned to a maternal child unit. Upon reporting for an assignment she was informed her patient would be having an abortion because of severe medical issues with the unborn child. She approached her preceptor immediately and asked to be reassigned to another patient because Sally was opposed to abortion for any reason. This is an example of:
a. Competent nursing care.
b. Staffing availability.
c. Conflict of conscience.
d. Fatigue.

Answer 43

c

Question 44

Michael a novice nurse has been assigned to four medically ill patients. There is a nursing staff shortage on his unit and more experienced nurses have as highly acute a workload as he does. As the shift progresses he becomes more distraught and unable to provide the type of care he knows his patients need. Michael is experiencing:
a. Moral distress.
b. Moral fatigue.
c. Values conflict.
d. Therapeutic relationship

Answer 44

a

Question 45

Mr. and Mrs. Bennett are attending a consult for reproductive assistance. Although there is a positive chance the method will result in a pregnancy, they are not able to cover the cost of the procedure. This situation denies which of the following ethical principles?
a. Autonomy.
b. Nonmaleficence. c. Justice.
d. Beneficence.

Answer 45

c

Question 46

To perform treatment on a patient not requiring a formal written consent a nurse must conduct which of the following? (Select all that apply.)
a. Asking permission to do a treatment.
b. Explaining the procedure.
c. Stopping the procedure if patient is uncomfortable.
d. Confirming understanding of the treatment.

Answer 46

a,b,c,d

Question 47

Nursing management actions and decisions are guided by (Select all that apply.)
a. The law.
b. Ethical principles.
c. Leadership style.
d. Professional accountabilities.
e. Staff preferences.

Answer 47

a,b,d

Question 48

Which of the following are core elements of relational ethics? (Select all that apply.)
a. Mutual respect.
b. Justice and beneficence.
c. Informed consent.
d. Interdependent environment.

Answer 48

a,d

Question 49

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the shift from 2300 to 0700 hours. The nurse manager knows that the best way to resolve the problem is to:
a. Use creativity.
b. Obtain support from staff of the shift from 0700 to 1500 hours.
c. Use institutional research.
d. Identify the problem.

Answer 49

D

Question 50

The nurse manager of a rehabilitation unit wants to purchase a new antiembolic stocking. To make a high-quality decision, the nurse manager would:
a. Involve the rehabilitation staff in the decision.
b. Involve the sales representative.
c. Make the decision alone.
d. Involve administration in the decision.

Answer 50

A

Question 51

Several nurses on an adolescent psychiatric unit complain that the teenagers are becoming unmanageable on the shift from 2300 to 0700 hours. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to:
a. Evaluate problem solutions.
b. Critique the ideas of other staff members.
c. Generate as many solutions as possible.
d. Identify only practical and realistic ideas.

Answer 51

C

Question 52

During a fire drill several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This decision style is most appropriate for:
a. Routine problems.
b. Crisis situations.
c. Managers who prefer an authoritarian style.
d. Followers who cannot agree on a solution.

Answer 52

B

Question 53

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:
a. Prevented conflict.
b. Formed highly cohesive groups.
c. Used majority rule to arrive at decisions.
d. Encouraged equal participation among members.

Answer 53

D

Question 54

To solve a problem, the nurse manager understands that the most important problem-solving step is:
a. The implementation phase.
b. Identification of numerous solutions.
c. Accurate identification of the problem.
d. Evaluation of the effectiveness of problem resolution.

Answer 54

C

Question 55

A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:
a. Stay out of it.
b. Inform the nursing supervisor.
c. Fill out a notification form (incident report).
d. Assess the risk to the client and the agency before proceeding.

Answer 55

D

Question 56

The clinic nurse understands that problem solving is best defined as
a. A higher order thinking process.
b. Selecting the best option for reaching a predefined goal.
c. Identifying “what is” and “what should be.”
d. Determining creative approaches to resolving a problem or issue.

Answer 56

C

Question 57

The risk manager wants to evaluate the reasons for an increased number of falls on the rehabilitation unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:
a. Identify the root causes of problems.
b. List possible solutions to problems.
c. Help leaders select the best options.
d. Evaluate the outcomes of decisions made.

Answer 57

A

Question 58

An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should:
a. Select the least expensive brand.
b. Use a decision-making tool to evaluate brands.
c. Ask the nursing staff which brand they prefer.
d. Select the vendor from which the institution usually buys.

Answer 58

B

Question 59

Which statement best defines the difference between problem solving and decision making?
a. Decision making skills require critical thinking; problem-solving skills do not.
b. Problem-solving skills require critical thinking; decision-making skills do not.
c. Decision making is a goal-directed effort; problem solving is focused on solving
an immediate problem.
d. Problem solving is a goal-directed effort; decision making is focused on solving an
immediate problem.

Answer 59

C

Question 60

Silvana, a nurse manager, has a staff nurse who has been absent a great deal for the past 3 months. A coworker gives some information to Silvana indicating that the staff nurse will be resigning and returning to school. Because of this Silvana decides to do which of the following?
a. Immediately fire the staff nurse.
b. Speak to the coworker and elicit more information.
c. Speak to the staff nurse and ask her to resign.
d. Do nothing.

Answer 60

D

Question 61

The maintenance department wishes to have the nursing lounge renovated so that the lounge will be more “user-friendly.” The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process?
a. Assessment/data collection. b. Planning.
c. Data interpretation.
d. Generating hypotheses.

Answer 61

A

Question 62

A good nursing decision maker is one who:
a. Uses various models to guide the process on the basis of the circumstances of the
situation.
b. Adopts one model and uses it to guide all decision making. c. Decides not to use any models because they are all useless. d. Develops a new model each time a decision has to be made.

Answer 62

A

Question 63

From the information supplied in this chapter, which statements best defines critical thinking? a. Critical thinking is a high-level cognitive process.
b. Critical thinking is a process that helps develop reflective criticism for the purpose
of reaching a conclusion.
c. Critical thinking is an orderly approach to considering problems, through the use
of knowledge of methods of logical inquiry and reasoning skills.
d. Critical thinking is a discussion that guides all aspects of the nursing process.

Answer 63

c

Question 64

Decision making is described by the nursing educator as the process that a person uses to
a. Solve a problem.
b. Choose between alternatives.
c. Reflect on a certain situation.
d. Generate ideas.

Answer 64

b

Question 65

Justin is a nurse manager in a rehabilitation unit in a small urban centre. There is a high turnover rate among rehabilitation assistants because of the heavy work assignments. Justin decides to hire new staff in the order that applications are received until all vacant positions are filled. Which of the following decisions did Justin make?
a. Subjective. b. Objective. c. Optimizing. d. Satisficing.

Answer 65

d

Question 66

Which of the following is an intuitive decision making model?
a. Fishbone model.
b. SWOT model.
c. Clinical judgement model.
d. Bounded rationality model.

Answer 66

c

Question 67

When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager’s first missed step in problem solving?
a. Not using a problem-solving model.
b. Not considering a number of alternatives.
c. Poor evaluation of outcomes.
d. Incorrect problem identification.

Answer 67

d

Question 68

One of three managers at a research laboratory drafted a policy that would allow his department to do more testing in his laboratory. This policy included the times for regular collection in addition to a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that:
a. The policy was too lengthy and inundated readers with too much detail.
b. The policy made decisions for other departments in the company.
c. The staff did not believe that the new policy would be effective.
d. Testing should not be done in the laboratory.

Answer 68

b

Question 69

Decisions are most likely to be of high quality in nursing situations when:
a. Team leaders make the crucial decisions.
b. Individuals are advised of the problems
c. Group size is neither too small nor too large. d. Members are passively involved.

Answer 69

c

Question 70

Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. Which situation would warrant individual decision making?
a. The task and the outcome are relatively simple.
b. It is unlikely that the group will reach a consensus.
c. A decision has to be discussed thoroughly.
d. A number of options need to be considered.

Answer 70

a

Question 71

Marcella, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off and the number of staff on vacation at any given time, in addition to its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?
a. Ask for requests for vacation time in advance, and post the times.
b. Post the completed vacation schedule.
c. Post a tentative schedule, and request feedback.
d. Post a blank schedule, and ask staff members to fill in their times by a given date.

Answer 71

d

Question 72

With regard to decision making, critical thinking, and problem solving, which of the following statements are accurate and valid points?
a. The professional decision maker approaches problem solving by beginning with an
outcome already in mind.
b. Involvement in decision making is of little use unless you are an expert
decision-maker.
c. Many models aid the nurse in improving his or her decision-making skills.
d. The nursing decision-maker who is successful recognizes that only those with
similar experiences should be involved in decision making.

Answer 72

c

Question 73

The two elements essential to solving any problem are:
a. Problem analysis and decision making.
b. Strategy and rationality.
c. Operational and strategic. d. Tactical and strategic.

Answer 73

a

Question 74

A decision making model based on a rational and logical approach to problem solving is termed:
a. Nursing process.
b. Ethical decision making.
c. Creative decision making.
d. Scientific decision making.

Answer 74

d

Question 75

Which decision-making model is based on the use of intuition when making a decision?
a. Bounded rationality.
b. Fishbone diagram.
c. Clinical judgement model.
d. Rational decision-making model.

Answer 75

c

Question 76

An efficient and useful technique for controlling negative group behaviours is: a. Six thinking hats.
b. SWOT analysis.
c. SOAR analysis.
d. Nominal group technique.

Answer 76

d

Question 77

Many factors affect decision-making such as bias. Which of the following reflect bias? (Select all that apply.)
a. Past experiences.
b. Personal attributes.
c. Creativity.
d. Intuition.

Answer 77

a,b

Question 78

In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? (Select all that apply.)
a. Identifying the assumptions that were underpinning the issues.
b. Considering the context of the current problem or situation.
c. Gathering data and evaluating all possible outcomes before making her decision.
d. Attaining a majority consensus of all staff.

Answer 78

a,b,c

Question 79

According to Leininger (2002), “cultural imposition” is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on people of other cultures. The discussion topic most likely to be without cultural imposition would be:
a. Abortion.
b. Wound management.
c. Blood transfusion.
d. Advance directives.

Answer 79

b

Question 80

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is:
a. The formation of a task force to commemorate a New Year’s celebration in the
Western tradition.
b. A project to provide Christmas gifts to the children in a daycare program.
c. Celebration of National Nurses’ Week with the focus on cultural care.
d. The formation of a task force to develop a poster for the unit depicting religions of
the world.

Answer 80

c

Question 81

One of the staff nurses on your unit makes the comment, “All this time I thought Mary was Black. She says she is Jamaican.” The best response would be:
a. “Who cares what she is?”
b. “What did you think when you learned she was Jamaican?”
c. “Why did you assume she was Black?”
d. “We have never had a Jamaican on this unit before.”

Answer 81

b

Question 82

As a nurse manager, you notice that Sharon, an Aboriginal licenced practical nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, “Why is it that when Nick and I work together in giving patient care, he jokes about my being ‘a little fat Eskimo’?” The nurse manager’s best response is, “Do you think he
a. Is sensitive to your culture?”
b. Wants to learn more about you?”
c. Has been hurt and wants to hurt others?”
d. Is stereotyping you without thinking?”

Answer 82

d

Question 83

The nurse manager of a unit is asked by a family member of a dying Inuit patient if it is possible to for the patient’s eight-member family to recite the rosary by the patient’s bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behaviour related to:
a. Acculturation.
b. Ethnocentricity.
c. Cultural diversity.
d. Cultural sensitivity.

Answer 83

d

Question 84

A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his “acupuncture doctor” for treatment of his migraine headache. The best response to this patient would be:
a. “How long have you been using acupuncture treatment?”
b. “Do you think acupuncture relieves your pain satisfactorily?”
c. “What have you told your heart specialist about your migraines and treatment?”
d. “Have you tried nonprescription pain medication or been given a prescription drug
for your headaches?”

Answer 84

a

Question 85

Maintaining a culturally diverse staff is an important function of a nurse manager who works in the hospital of a large medical centre. According to Health Canada (2008), which cultural group represents about 2% of registered nurses employed in Canada? The chapter states 3% p. 11.
a. Men.
b. Aboriginal.
c. French Canadian.
d. African Canadian

Answer 85

b

Question 86

Because an increasing number of Aboriginal patients are being admitted, a nurse manager
designs a staff-development program for her staff to help them understand Aboriginal culture. A nurse should understand that culture is determined by which of the following?
a. Behaviour.
b. Love for people.
c. Shared vision.
d. Rapid time passage.

Answer 86

a

Question 87

The nurse manager for a unit’s culturally diverse staff creates a staff-development program so that the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that what characteristics are inherent in a culture?
a. It develops over time.
b. It maintains a strong work ethic.
c. It changes easily.
d. It develops quickly.

Answer 87

a

Question 88

Which principle of The Canada Health Act is frequently not upheld in rural and remote areas of the country?
a. Comprehensiveness.
b. Public administration.
c. Accessibility.
d. Portability.

Answer 88

c

Question 89

Within the deaf community, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of:
a. Dominant versus nondominant behaviours.
b. The need to recognize diversity within groups.
c. The effect of cross-culturalism

Answer 89

b

Question 90

When interviewing a candidate for a nursing position who has an Aboriginal background, a non-Aboriginal nurse recognizes that the candidate’s lack of eye contact reflects the candidate’s:
a. Lack of confidence.
b. Professional behaviour.
c. Cultural sensitivity.
d. Ethnicity.

Answer 90

d

Question 91

Recognizing that the Aboriginal candidate’s lack of eye contact is different from her own, the non-Aboriginal nurse is exhibiting
a. Acculturation.
b. Cultural sensitivity.
c. Ethnocentrism.
d. Transculturalism

Answer 91

b

Question 92

A non–English-speaking patient arrives at the nursing unit. The nurse knows that when patient communication is hampered by the inability to communicate in the same language, it may lead to:
a. Inequities in accessing health care services.
b. Inability to obtain health insurance.
c. A decrease in patient morbidity.
d. Lack of portability with health care coverage.

Answer 92

a

Question 93

At Health Centre XYZ, staff members on the rehabilitation unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in privacy and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of:
a. Ethnicity.
b. Work environment.
c. Work culture.
d. Marginalization.

Answer 93

c

Question 94

Which of the following enables people to make sense of situations that they may encounter that differ from their circle of familiarity?
a. Paradox.
b. Prejudices.
c. Power. d. Position.

Answer 94

b

Question 95

During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgement of patients’ feelings. Xia bursts into tears and leaves the office. Later, you learn that in Xia’s culture, criticism is perceived as akin to failure. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of:
a. Bias.
b. Cultural awareness.
c. Cultural diversity.
d. Ethnocentricity.

Answer 95

b

Question 96

Individuals living with asthma, who also live in poverty, are much less likely to seek early care than to go to emergency rooms for assistance. This example reflects:
a. Stereotyping.
b. Cultural diversity.
c. Ethnocentricity.
d. Transcultural care.

Answer 96

d

Question 97

Serena, RN complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Serena, you consider that differences across cultures that are relevant to this situation include:
a. Eye contact.
b. Personal space.
c. Harassment.
d. Expressions of feeling.

Answer 97

b

Question 98

A new graduate registered nurse joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not in her program. She is best described as:
a. Having cultural sensitivity.
b. Experiencing cultural diversity.
c. Experiencing cultural marginality.
d. Experiencing acculturation.

Answer 98

c

Question 99

In caring for a patient from an East Indian culture, staff members express frustration that many friends and family members are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behaviour of the family and friend network reflects:
a. Lack of understanding of the seriousness of the patient’s illness.
b. Lack of communication between family members.
c. The social organization of friendships and family networks in East Indian culture.
d. Lack of caring about the hospital environment by the friends and family.

Answer 99

c

Question 100

In coaching Monique to become more culturally sensitive when a patient has requested a smudge ceremony at the bedside, you suggest which of the following?
a. “Explain to Jim that there is no smoking in the hospital.”
b. “Inform Jim that fires are not allowed in the hospital.”
c. “Insist that he give you his tobacco because it is unhealthy for him.”
d. “Ask him what he means by a ‘smudge ceremony’ and what meaning it has for
him.”

Answer 100

d

Question 101

A constructivist perspective of culture recognizes which of the following influence an individual’s understanding of culture? (Select all that apply.)
a. Social context.
b. Is changeable.
c. Political understanding.
d. Economic status.

Answer 101

a,b,d

Question 102

2. To ensure cultural safety regarding the use of language it is essential to address which of the following? (Select all that apply.)
   a. Uses common points of reference in practice.
   b. Count on a word for word translation.
   c. Ensure linguistic equivalence in both languages.
   d. Think any translator is adequate.

Answer 102

a,c

Question 103

New immigrants to Canada have a limited understanding of the Canadian health care system. Nurse leaders must ensure that staff use effective communication to ensure patients have the knowledge to understand their rights to health care. Good communication can be achieved through which of the following? (Select all that apply.)
a. Understanding one’s own prejudices.
b. Allowing time for interpreting and clarifying information.
c. Presuming openness exists between people of different cultures.
d. Recognizing providing care to diverse groups is a dynamic and complex
experience.

Answer 103

a,b,d

Question 104

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following attributes of a nurse manager would assist you in addressing the cultural needs of your staff? (Select all that apply.)
a. Stereotyping of others.
b. Respect for others.
c. Positive reinforcement.
d. Knowledge about your staff.
e. Age bias.
f. Disrespect for others.

Answer 104

b,c,d

Question 105

A nurse manager was orienting new staff members with regard to computerized charting. To understand computerized charting, staff members must understand informatics. Which of the following are the core concepts in informatics?
a. Hardware, software, competency, and printers.
b. Data, information, knowledge, and wisdom.
c. Decision making, data gathering, data analysis, and reporting.
d. Wireless technology, voice recognition, and handheld devices.

Answer 105

b

Question 106

The clinic nurse has just accessed a patient’s chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that patient’s chart. What should she say?
a. “No problem. Just log me off when you’re done.”
b. “I’ll put the note in for you. What do you want to say?”
c. “Just make sure that you sign your note because it’s under my password.”
d. “I’m sorry, but you will have to enter the information using your own password

Answer 106

d

Question 107

A home health nurse has been assigned to cover a 500-km2 area of remote Alberta. Mrs. Banister has just been discharged home and will need daily contacts for the next week. Because it is not possible to visit Mrs. Banister in person every day and see all the other patients, the nurse gives her a laptop computer with Internet meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether the patient needs to be seen that day. This type of technology is called:
a. Distance learning.
b. Knowledge software.
c. Telecommunications.
d. Biomedical technology.

Answer 107

c

Question 108

The chief nursing officer understands that to be able to compare data across patient populations and sites, it is important that nurses use:
a. Similar settings.
b. Information systems.
c. Knowledge systems.
d. Consistent nursing languages.

Answer 108

d

Question 109

Leaders in nursing must advocate for information and knowledge systems that support nursing practice. How is this best accomplished?
a. Participating in organizational information technology committees.
b. Submitting written requests for needed information systems.
c. Requesting budgetary funds needed for systems.
d. Sending staff nurses to conferences that discuss cutting-edge technologies.

Answer 109

a

Question 110

You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you obtain and present patient data from which of the following?
a. A clinical database.
b. Biomedical technologies.
c. Email.

Answer 110

a

Question 111

As the head nurse involved in determining which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. What does this particular aim recognize?
a. Human error is significant in contributing to adverse events.
b. Documentation of patient data is often illegible and therefore misinterpreted.
c. Data systems provide backup documentation with adverse events that staff cannot
provide.
d. Physiologic monitoring systems enable detection of early changes before an
adverse event occurs.

Answer 111

d

Question 112

As a nurse manager in a multisite facility, you are comparing the effectiveness of prompted voiding training programs for staff by examining the effect of prompted voiding on the frequency of incontinence in patients. To do this, you access an NMDS, which allows you to:
a. Retrieve standardized information regarding patient care and trends.
b. Access medical diagnoses and pharmacologic interventions.
c. Learn sociodemographic and population-based trends.
d. Find information on public funding and private health insurance revenues.

Answer 112

a

Question 113

When assessing the appropriateness of adopting personal digital assistants (PDAs) for a nursing unit, you need to consider which of the following advantages?
a. Lower cost in relation to personal computers.
b. Small display screen.
c. Font size.
d. Speed of operation

Answer 113

a

Question 114

A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point for this. What characteristic would lead to this conclusion?
a. SR systems are not available outside pilot projects.
b. The type of speech required for voice recognition is unlikely in a pressured
situation.
c. The hands-free function has not been perfected in SR technology.
d. Wireless communications are prone to unreliability in transmission.

Answer 114

b

Question 115

For a nurse manager, one challenge is to orient new staff to the agency’s policies and procedures, and also to provide training across various shifts. Which of the following would be a cost-effective and effective learning strategy?
a. Development of new learning modules and software to support document retrieval.
b. Email distribution to staff home email addresses regarding important policies.
c. Preparation of digital video disks (DVDs) that can be viewed on computers at the
nursing station during “down times.”
d. Linking policies and procedures to the network for access when required at the
point of care.

Answer 115

d

Question 116

What is the most critical factor in ensuring nurses’ comfort and knowledge in the use of technology in health care regardless of age, education level, or area of practice?
a. Confidence in using technology.
b. Adequacy and substance of professional development.
c. Repeated training sessions. d. Peer and leader support.

Answer 116

b

Question 117

Peggy, a nurse leader on a busy medical surgical unit, is concerned that the rapid expansion in use of EHRs and clinical decision support systems may lead to leaked patient information and breach of confidentiality. She decides to form a nurse led committee to address these concerns. Which of the following must be addressed to prevent breach of confidentiality? (Select all that apply.)
a. Assign a password that uniquely identifies a user to the system by name and title.
b. Ensure nurse confidentiality through ongoing discussion.
c. Ensure nurses understand privacy legislation that applies to them, and their work
setting.
d. Monitor individual nurses.

Answer 117

a,b,c

Question 118

Nurses rely on technology to lessen the number of adverse events that are well documented, yet are challenged in keeping the unique therapeutic relationship between nurse and patient with increasing use of technology. What approaches can be used to ensure the therapeutic relationship is preserved (Select all that apply.)
a. Involving patients in decisions about their own care.
b. Actively listening while conducting electronic charting.
c. Showing patients what is being documented.
d. Repeatedly monitoring equipment while documenting.

Answer 118

a,b,c

Question 119

As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes which of the following? (Select all that apply.)
a. Reduction in incidents of medication error.
b. Immediate documentation of care.
c. Improving discharge planning.
d. Increasing confusion with nursing workflow.

Answer 119

a,b,c

Question 120

The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following?
a. Increasing the total number of staff on the unit.
b. Increasing the staff and registered nurse (RN) hours per patient.
c. Increasing the total number of staff and implementing 12-hour shifts.
d. Increasing the number of RNs and number of RNs with experience on the unit.

Answer 120

d

Question 121

A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy rate of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being;
a. 90%.
b. 85%. c. 75%. d. 60%.

Answer 121

b

Question 122

To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers:
a. Work time, educational time, and holiday time.
b. Paid hours minus worked hours.
c. Vacation time, holiday time, and sick time.
d. Paid hours minus meeting time.

Answer 122

c

Question 123

An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to:
a. Assign staff on the unit on a daily basis.
b. Ensure that days off are planned for the staff.
c. Outline the number of individuals by classification on a per-shift basis.
d. Predict the numbers and classifications of float staff needed to augment regular
staff.

Answer 123

c

Question 124

A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit’s staffing needs. An external consideration is:
a. Organizational staffing policies.
b. Staffing models.
c. Changes in services that will be offered.
d. Department of Health licensing standards.

Answer 124

d

Question 125

A nurse manager must also consider a number of internal variables that will affect staffing patterns. Which of the following is an internal variable to be considered?
a. Organizational staffing policies.
b. Provincial/territorial licensing standards.
c. Canadian Nurses Association guidelines.
d. Consumer expectations.

Answer 125

a

Question 126

A nurse manager uses many sources of data when planning the unit’s workload for the year. Which of the following data must be considered in the planning?
a. Hours of operation of the unit.
b. Trends in the numbers of acutely ill patients on the unit.
c. Maximum work stretch for each employee.
d. Weekend requirements.

Answer 126

b

Question 127

Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must schedule:
a. All weekends off.
b. All holidays off.
c. A variety of scheduling options.
d. Rotating shifts.

Answer 127

c

Question 128

The difference between staffing and scheduling is that staffing:
a. Puts the right person in the right position.
b. Puts the right person in the right time and place.
c. Refers to the number of nursing hours per patient per day.
d. Accounts for interpretation of benefits and compensatio

Answer 128

a

Question 129

A busy neurologic intensive care unit and a step-down unit are most likely to use which patient classification system?
a. Factor evaluation.
b. Prototype evaluation.
c. Canadian National Database of Nursing Quality Indicators.

Answer 129

a

Question 130

Factor evaluation systems involve classification systems in which:
a. Financial data are used to determine staff-to-patient ratios.
b. Diagnosis-related groups are used to determine the numbers of acutely ill patients
on a unit.
c. Interventions and time required for interventions are combined to determine the
levels that are required.
d. Financial resources and nursing interventions are combined to determine patient
contact hours.

Answer 130

c

Question 131

Staff members on your unit raise concern that the number of acutely ill patients on the unit is rising and responsiveness in addressing these needs through appropriate staffing is lacking. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, the best action for your hospital organization is to:
a. Implement a patient classification system immediately.
b. Participate in databases that compare the outcomes and staffing levels versus those
of institutions similar to yours.
c. Provide increased numbers of staff to the unit.
d. Ignore such concerns because the number of acutely ill patients is variable.

Answer 131

b

Question 132

A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities such as prompted voiding require higher staff utilization than do dependent activities but do not result in increased staff resources. This is an example of:
a. Bureaucracy.
b. Concern related to the validity of classification systems.
c. Inadequate reliability of classification systems.
d. Inappropriate subjectivity in making judgements about staffing.

Answer 132

b

Question 133

In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for:
a. Higher patient care hours.
b. Safer facilities.
c. Institution of a patient classification system.
d. An increased number of RN positions.

Answer 133

d

Question 134

In evaluating mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher on the weekend than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on:
a. Availability of diagnostic personnel.
b. Availability of physicians.
c. Communication with on-call providers.
d. Numbers of acutely ill patients.

Answer 134

c

Question 135

What does a nurse staffing plan take into account?
a. Specific nurse-to-patient ratios per shift.
b. Participation of nurses in projecting staffing needs.
c. Compensation and benefits for each level of staff. d. The occupancy load of a unit.

Answer 135

b

Question 136

As the unit manager you post the staffing plan and compliance reports. This initiative is aimed at:
a. Maintaining unit morale.
b. Complying with national requirements.
c. Demonstrating patient outcomes.
d. Inviting staff participation in decision making.

Answer 136

a

Question 137

18. To maintain patient safety, studies suggest that scheduling should avoid which of the
    following?
    a. Rotating shifts.
    b. Weekends.
    c. Eight-hour shifts.
    d. Mandatory overtime.

Answer 137

a

Question 138

In a job interview for a staff position, which of the following indicates your knowledge of patient safety?
a. “Will I be able to get overtime hours on your unit?”
b. “If there is an opportunity to work extra shifts, I would really like that.”
c. “Is there a strategy in place to reduce the number of overtime hours on the unit?”
d. “I see no reason why I wouldn’t be able to work overtime.”

Answer 138

c

Question 139

To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the health care organization:
a. Develops a centralized pool of float nurses.
b. Assigns nurses from less busy units to ones with increased numbers of acutely ill patients.
c. Floats nurses only between units on which the nurses have been cross-trained.
d. Assigns float nurses to basic care only.

Answer 139

a

Question 140

To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following?
a. Maximum productive hours.
b. Average nonproductive hours.
c. Minimum benefit hours.
d. Maximum vacation time.

Answer 140

b

Question 141

Your health care organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to:
a. Seek budgetary approval.
b. Balance personal schedules against institutional needs.
c. Negotiate the schedule with unit staff.
d. Submit the schedule to a centralized staffing office for review.

Answer 141

d

Question 142

Patient classification systems have been developed in an effort to give nurse managers the tools and language to describe the acuity of patients. “Sicker” patients receive higher classification scores, indicating that more nursing resources are required to provide patient care. Which of the following describes a factor evaluation system?
a. Subjective and descriptive.
b. More objective.
c. Uses broad categories to predict patient-care needs.
d. Patient-care needs based on diagnosis-related groups.

Answer 142

b

Question 143

Which of the following decrease the risk of patient mortality rates? (Select all that apply.)
a. Staff burnout.
b. Positive leadership support.
c. Increase of casual or temporary positions.
d. Staffing numbers and levels.

Answer 143

a,d

Question 144

The growth in evidence on nursing-sensitive indicators has been accompanied by significant controversy regarding the level of nurse staffing required for various groups of patients, primarily in acute-care hospitals. Two major approaches to sufficient staffing have been put forward in Canada. These are? (Select all that apply.)
a. Mandated nurse-patient ratios
b. Increased numbers of registered nurses
c. Development of a staffing plan for a period of time
d. Better staff mix

Answer 144

a,c

Question 145

Eschiti and Hamilton (2011) learned that support services and numbers of nonnurse staff are greatly diminished on off-peak shifts leading to increased mortality rates. Which of the following factors influence the risk to patients in off-peak times (weekends and evenings and night shifts)? (Select all that apply.)
a. Rotating shifts
b. Mandatory overtime hours
c. Good staff mix
d. Nurse fatigue

Answer 145

b,d

Question 146

In reviewing the job description of a nurse manager, the staff members become aware that a nurse manager’s role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.)
a. Responsibility for nursing benchmarks.
b. No responsibility for knowledge of staffing benchmarks.
c. Responsibility for planning staffing of unlicensed assistive personnel only.
d. Preparing a unit budget
e. Changing staffing plans on the basis of service needs.

Answer 146

a,d,e

Question 147

The nurse manager schedules evaluations of staff members by using a newly developed performance appraisal tool. The development of a performance appraisal tool should include:
a. The organizational mission and philosophy and the position requirements.
b. A generalized overview of the duties of a position.
c. A skills checklist and accreditation requirements.
d. An ordinal scale that ranks all employees.

Answer 147

a

Question 148

Joshua, a new graduate, reviews the employee evaluation for his new position. The first
section requires that he list his own specific objectives to be accomplished. This is an example
of:
a. The traditional rating scale.
b. Learning goals or management by objectives.
c. A forced distribution scale.
d. A behaviourally anchored rating scale (BARS).

Answer 148

b

Question 149

Joshua notes that the next section of the evaluation tool is specific to the organizational philosophy and has a four-point ordinal scale that describes performance from “always meets expectations” to “does not meet expectations.” This type of evaluation is most commonly known as:
a. A BARS.
b. Management by objectives/learning goals.
c. The forced distribution scale.
d. A traditional rating scale.

Answer 149

d

Question 150

On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement?
a. Peer review.
b. A combination of tools.
c. Anecdotal notes.
d. Rating scale.

Answer 150

d

Question 151

Which of the following is a strategy that clinical nurse educators can use to ensure understanding and retention of information in newly hired staff nurses?
a. Provide written information of all orientation topics.
b. Evaluate whether there is fit between learner and organizational values.
c. Develop a range of strategies that cover a variety of learning styles.
d. Organize group sessions for orientation to increase cost effectiveness.

Answer 151

c

Question 152

Which of the following might best conclude an interview?
a. “Thank you for your interest. Someone will be in touch with you soon.”
b. “Before you go, we will make sure that we have your contact information. Thank
you for coming.”
c. “I will be in contact with all candidates by telephone by next Friday. It has been a
pleasure to meet you.”
d. “We have several excellent candidates so I am not sure about the outcome of the
interview, but I will let you know. Thank you for coming.”

Answer 152

c

Question 153

In addressing the primary challenge in recruitment of new staff, which of the following interview questions might be asked?
a. “Could you review your resume for us, highlighting your certifications and
experience?”
b. “If we were to ask your references, what would they list as your strengths? Weaknesses?”
c. “We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?”
d. “Tell us about your work and academic experiences and qualifications.”

Answer 153

c

Question 154

The biggest challenge in the recruitment of staff is:
a. Finding well-qualified candidates who can function well within a particular work
culture.
b. Recruiting individuals with the appropriate qualifications and experience.
c. Screening out candidates who are unable to function well within a team.
d. Determining whether candidates have had previous negative experiences in a work
environment.

Answer 154

a

Question 155

Anecdotal notes:
a. Should be completed only when there are performance concerns.
b. Can be used to support and justify fairness in termination discussions.
c. Are unnecessary if the evaluation instrument is thorough.
d. Need to be completed at the end of a performance period.

Answer 155

b

Question 156

An outpatient clinic advertised for registered nurse positions. Before authorizing a position opening, the nurse manager should:
a. Review the position description and performance expectations for the opening.
b. Place an advertisement in the local newspaper and on the telephone job line.
c. Review all current applications on file.
d. Look for employees within the system who might best fill the position.

Answer 156

a

Question 157

Yasmine is a likable and popular staff member. Despite occasional complaints from patients about inappropriate comments and rough handling of patients, Yasmine continues to receive positive performance appraisals. This is an example of:
a. A halo effect.
b. Rare conflict.
c. Role ambiguity.
d. Evaluator bias.

Answer 157

a

Question 158

The validity of comments and ratings related to performance is enhanced by which of the following:
a. Maintenance of anecdotal notes over the entire evaluation period.
b. Quantity of information gathered for appraisal purposes.

c. Agreement of the employee with the ratings and comments.

d. Whether other individuals have contributed to the observations.

Answer 158

a

Question 159

A nurse manager in the intensive care unit works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for a registered nurse working on that unit. What type of appraisal is this?
a. Rating scale.
b. Collaboratively based appraisal system.
c. Narrative instrument.
d. BARS.

Answer 159

d

Question 160

The primary disadvantage of a BARS is that it is:
a. Situation specific.
b. Well understood by the staff.
c. Too generalized.
d. Expensive to develop.

Answer 160

d

Question 161

Marcia, a nurse manager, discusses her concerns about the hospital’s employee appraisal system with her work group, noting that all it includes is one rating scale, which means nothing unless the manager is effective in her job. Marcia’s concerns reflect which best practices associated with performance appraisal?
a. Rating scales are too generalized to be considered valid or reliable.
b. The effectiveness of any appraisal system is tied directly to the skills and
communication abilities of the manager.
c. BARS are considered superior to simple rating scales in terms of performance
appraisal.
d. Rating scales need to be designed by users to be well accepted.

Answer 161

c

Question 162

During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider:
a. Alysha’s level of confidence.
b. Whether mentoring is included in the position description.
c. Whether mentoring is an essential component of the position description.
d. Whether mentoring can be accurately observed and measured.

Answer 162

b

Question 163

As a manager, you are interested in developing behavioural questions for an interview. You know that there is team conflict at times on your unit. Which of the following questions would satisfy your interest in behavioural questions?
a. “Tell me about a time you were involved in a conflict related to a project. What
was your role in the conflict? In the resolution of the conflict?”
b. “If you were to employ one strategy for managing conflict, what would it be?”
c. “What is your preferred style of conflict resolution?”
d. “How effective are you in working in a group? In dealing with conflict?”

Answer 163

a

Question 164

Which of the following strategies might be effective in empowering staff?
a. Communication book in which new information on policies and processes is
communicated and mistakes are highlighted.
b. Monthly staff meetings during which a portion of the agenda is devoted to sharing
ideas and presentations on best practices for implementation on the unit.
c. Once-yearly summative evaluations based on what the manager likes best about
each individual.
d. Immediate discussion of errors in care and with involved staff with direction as to
how errors are to be prevented in the future.

Answer 164

b

Question 165

The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are:
a. Shared values, high salaries, and a human focus.
b. Shared values, flexibility, and a human-capital focus.
c. Commitment to communication, high salaries, and flexibility for evaluations.
d. Creation of community and of effective stress management in the midst of
divergent goals.

Answer 165

b

Question 166

Nora, a new nurse manager, writes certain assumptions regarding the organization’s objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization and that she needs to clarify these objectives with her supervisor. Nora apologizes and says she had more latitude with the budget where she previously worked. This is an example of:
a. Role complexity.
b. Role ambiguity.
c. Role conflict.
d. Time-dependent roles.

Answer 166

b

Question 167

A survey of staff satisfaction is conducted. The results indicate that staff members are satisfied, are loyal to the organization, and believe that they have reasonable control in their individual responsibilities. The findings best exemplify:
a. Clarity in roles and valuing of contributions.
b. Satisfaction but not empowerment.
c. Effective coaching of new staff.
d. Role attachment.

Answer 167

a

Question 168

You have hired Bumika as a new staff member on your unit. Although she is an experienced intensive care unit nurse, this is her first educator role. A month into her new position she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of:
a. Role acquisition.
b. Role conflict.
c. Role complexity.
d. Performance appraisal.

Answer 168

a

Question 169

An environment that fosters misunderstanding and that hinders effective communication leads to:
a. Role conflict.
b. Role ambiguity.
c. Role clarity.
d. Role certainty.

Answer 169

b

Question 170

Nurse Managers are increasingly being held accountable for nurse retention. Which of the following actions should a nurse manager focus on to retain nurses? (Select all that apply.) a. Support and encourage employees.
b. Clarify the organization’s mission.
c. Be unclear about expectations.
d. Select the right person for the right position.

Answer 170

a,b,d

Question 171

In staff development which of the following would support retention of nurses? (Select all that apply.)
a. Residency-type programs for new graduates.
b. Preceptorship program.
c. Nonexistent ongoing staff development plan.
d. Orientation to the role and the organization.

Answer 171

a,b,d

Question 172

Coaching is an approach that retains nurses. Which of the following are coaching behaviours? (Select all that apply.)
a. Is costly.
b. A learned process.
c. Promotes optimal performance.
d. Is a personal approach.

Answer 172

b,c,d

Question 173

During the performance appraisal session, what should the manager do? (Select all that apply.)
a. Maintain a relaxed and professional manner.
b. Inquire about the employee’s personal life and how it is affecting performance.
c. Allow the employee to express opinions orally and in writing.
d. Plan to give specific examples only for poor performance.

Answer 173

a,c

Question 174

A new graduate is asked to serve on the hospital’s quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to:
a. Collect data to determine whether standards are being met.
b. Implement a plan to correct the problem.
c. Identify the standard.
d. Determine whether the findings warrant correction.

Answer 174

c

Question 175

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio?
a. “It promotes teamwork among health care providers.”
b. “It increases adverse events.”
c. “It improves outcomes.”
d. “It contributes to duplication of services.”

Answer 175

c

Question 176

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a philosophy of total quality management (QM) by:
a. Explaining to the staff that disciplinary action will be taken in cases of additional
errors.
b. Recommending that a multidisciplinary team assess the root cause of errors in
medication.
c. Suggesting that the pharmacy department explore its role in the problem.
d. Changing the unit policy to allow a certain number of medication errors per year
without penalty.

Answer 176

b

Question 177

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to QI, to correct the problem the educator, in consultation with the patient care manager, would initially do which of the following?
a. Talk to the staff individually to determine why this is occurring.
b. Call a meeting of all staff to discuss this issue.
c. Have a group of staff nurses review the established standards of care for
postoperative patients.
d. Document which staff members are not recording vital signs, and write them up.

Answer 177

b

Question 178

Before beginning a continuous QI project, a nurse should determine the minimal safety level of care by referring to which of the following?
a. The procedure manual.
b. Nursing care standards.
c. The litigation rate of unsafe practice.
d. Job descriptions of the organization.

Answer 178

b

Question 179

The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that:
a. The error will result in suspension.
b. An incident report is optional for an event that does not result in injury.
c. The error will be documented in her personnel file.
d. Risk management programs are not designed to assign blame.

Answer 179

d

Question 180

With the rise of workplace violence in the emergency department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should:
a. Request all staff to accept new risk management practices.
b. Hold staff accountable for safe practices.
c. Document inappropriate behaviour.
d. Hire more police security.

Answer 180

b

Question 181

The nurse manager is performing a root-cause analysis related to medication administration errors with insulin. A root-cause analysis is very similar to the QI process except that a root-cause analysis is:
a. Retrospective.
b. Prospective.
c. Legislated for completion with all near-miss events.
d. Conducted by only one person.

Answer 181

a

Question 182

Hospital ABCD is a Magnet hospital. This designation has been applied to Hospital ABCD because it:
a. Facilitates active staff participation in decision-making related to quality nursing care.
b. Has implemented a graduate nurse orientation program.
c. Espouses commitment to excellence in patient care.
d. Is establishing career ladders for nurses.

Answer 182

a

Question 183

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence?
a. Best Practice Guidelines (BPGs).
b. North American Nursing Diagnosis Association (NANDA).
c. National Quality Institute.
d. Agency for Healthcare Research and Quality.

Answer 183

a

Question 184

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because:
a. The return rate on patient questionnaires is frequently low.
b. Patients are rarely reliable sources about their own hospital experiences.
c. Hospital experiences are frequently obscured by pain, analgesics, and other factors
affecting awareness.
d. Patients are reliable sources about their own experiences, but are limited in their
ability to gauge clinical competence of staff.

Answer 184

d

Question 185

Patient perceptions are useful in:
a. Determining disciplinary actions in QI.
b. Establishing the competitive advantage of QI decisions.
c. Establishing priorities among possible changes to care identified in QI.
d. Establishing blame for poor-quality care.

Answer 185

c

Question 186

A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate?
a. Histogram.
b. Flowchart.
c. Fishbone diagram.
d. Pareto chart.

Answer 186

a

Question 187

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. Such a determination is known as:
a. Quality assurance.
b. Sentinel data.
c. Benchmarking.
d. Statistical analysis.

Answer 187

c

Question 188

At Hospital Ajax, staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame. This culture demonstrates:
a. QM principles that emphasize customer safety.
b. a deep concern with improvement of quality and processes.
c. effective employee orientation and development in relation to QM.
d. goals that are inconsistent with QM.

Answer 188

d

Question 189

Which of the following is not a principle of high reliability organizations?
a. Sensitivity to operations.
b. Preoccupation with failure.
c. Commitment to resiliency.
d. Reluctance to simplify.
e. Indeference to expertise.

Answer 189

e

Question 190

The ability to compare data across health care sectors or organizations, such as hospital acquired infection or hand hygiene rates may be hindered by?
a. Reluctance to share information.
b. Fear of reduced funding.
c. Fear of reduced reputation.
d. Differences in terminology.

Answer 190

d

Question 191

The QI process begins with:
a. identifying implications for practice.
b. identifying the aim.
c. team assembly.
d. sustaining the improvements.

Answer 191

b

Question 192

Examples of sentinel events include (Select all that apply.)
a. Forceps left in an abdominal cavity.
b. Patient fall, with injury.
c. Short staffing.
d. Administration of morphine overdose.
e. Death of patient related to postpartum hemorrhage.

Answer 192

a,b,d,e

Question 193

A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff members want to keep their old procedures, and they resist the changes. Conflict arises from:
a. Group decision-making options.
b. Perceptions of injustice.
c. Increases in group cohesiveness.
d. Debates, negotiations, and compromises.

Answer 193

b

Question 194

Two staff nurses are arguing about working on holidays. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when:
a. Risk taking seems to be unavoidable.
b. People see events differently.
c. Personal and professional priorities do not match.
d. The ways in which people should act do not match the ways in which they do act.

Answer 194

b

Question 195

The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a provincial health department visit, so she ignores the problem. A factor that can increase stress and escalate conflict is:
a. The use of avoidance.
b. An enhanced nursing workforce.
c. Accepting that some conflict is normal.
d. Managing the effects of fatigue and error.

Answer 195

a

Question 196

The nurse manager decides to use a mediator to help resolve the conflict among staff. Which of the following is a basic strategy for truly addressing this conflict?
a. Identify the conflicting facts.
b. Be determined to resolve the conflict.
c. Schedule a meeting time for resolution.
d. Have a clear understanding of the differences between the parties in conflict.

Answer 196

d

Question 197

Ylena, a staff nurse on your unit, witnesses another nurse striking a patient. Ylena wants to remain friends with her colleague and worries that confrontation with her colleague or reporting her colleague will destroy their relationship. Ylena is experiencing which type of conflict?
a. Intrapersonal. b. Interpersonal. c. Organizational. d. Professional.

Answer 197

a

Question 198

The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are:
a. Frustration, competition, negotiation, and action.
b. Frustration, conceptualization, action, and outcomes.
c. Frustration, cooperation, collaboration, action, and outcomes.
d. Frustration, conceptualization, negotiation, action, and outcomes.

Answer 198

b

Question 199

A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the class that conflict in an organization is important and that an optimal level of conflict will generate which of the following?
a. Creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its
workers.
b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.
c. Creativity, a problem-solving atmosphere, growth, and motivation for its workers.
d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

Answer 199

c

Question 200

Jane has transferred from the intensive care unit to the critical care unit. She is very set in the way she makes assignments and encourages her new peers to adopt this method without sharing the rationale for why it is better. This is a good example of a process and procedure that creates ________ conflict.
a. Organizational. b. Intrapersonal. c. Interpersonal. d. Disruptive.

Answer 200

c

Question 201

Two nurses on a psychiatric unit come from different backgrounds and have graduated from different universities. They are given a set of new orders from the unit manager. Each nurse displays different emotions in response to the orders. Nurse A indicates that the new orders include too many changes; Nurse B disagrees and verbally indicates why. This step in the process is which of the following in Thomas’s (1992) four stages of conflict?
a. Frustration.
b. Conceptualization. c. Action.
d. Outcomes.

Answer 201

b

Question 202

Mrs. Gordon, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysphagia. During visiting hours, Mr. Gordon fed his wife some noodles. The nurse noticed this and stopped Mr. Gordon from feeding his wife, telling him it was the doctor’s decision. An hour later, the nurse returned and found Mr. Gordon feeding his wife again. The nurse tried to stop him again. Mr. Gordon refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Gordon’s chart. According to Thomas’s (1992) four stages of conflict, in which stage could the nurse have been more effective?
a. Frustration.
b. Conceptualizing. c. Action.
d. Outcomes.

Answer 202

c

Question 203

Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other for mistakes, and a resolution has not occurred in months. To solve the existing conflict, which is the most desirable conflict resolution?
a. Avoiding.
b. Competing.
c. Compromising. d. Collaborating.

Answer 203

d

Question 204

A nurse educator is giving a workshop on conflict. During the sessions he makes various statements regarding conflict. All of the following statements are true except:
a. “Conflict can decrease creativity, thus acting as a deterrent for the development of
new ideas.”
b. “Conflict can arise over the most trivial issues.
c. “A variety of definitions of conflict are known.”
d. “All conflicts involve some level of disagreement.”

Answer 204

a

Question 205

The nurse manager performs his role in a way that he believes empowers his staff; however, the staff feel smothered by his micromanagement approach. This is a good example of which of the following conditions that propel a situation toward conflict?
a. Incompatible goals.
b. Role conflicts.
c. Structural conflict.
d. Competition for resources.

Answer 205

a

Question 206

Kala, a unit manager, in discussing a role the hospital’s chief executive officer would like her to perform, makes the following statement, “I will sit on the hospital task force on improving morale if you send me to the hospital’s leadership training classes next week, so I can further develop my skills and thus be more effective.” Which of the following conflict management styles is Kala using?
a. Collaborating.
b. Avoiding.
c. Negotiating.
d. Accommodating.

Answer 206

c

Question 207

Marcus is a circulating nurse in the operating room. He is usually assigned to general surgery, but on this day he is assigned to the orthopedic room. He is unfamiliar with the routines and studies the doctor’s preference cards before each patient. The fourth patient comes into the room, and Marcus prepares a site for a biopsy by using a Betadine solution. The surgeon prefers another solution. He notices what Marcus has done and immediately corrects him by rudely insulting him. Which of the following is the most appropriate approach to conflict resolution in this example?
a. Collaboration. b. Compromising. c. Avoiding.
d. Withdraw.

Answer 207

b

Question 208

Successful resolution of conflict yields constructive outcomes and leads to:
a. Inhibition of movement.
b. Improved team functioning.
c. Diminished resolutions.
d. Lower employee satisfaction levels.

Answer 208

b

Question 209

The head nurse and a staff nurse are having a conflict over how to use and apply a new
procedure for dressings in the medical/surgical unit. The staff nurse wishes to use the new
procedure, which is based on newly released nursing research. The head nurse wishes to use
a protocol that has been used in the department for a number of years. The head nurse later
makes comments to other staff on her unit
about the credibility of the staff nurse. This
behaviour is associated with:
a. Lateral violence.
b. Horizontal violence.
c. Confrontation.
d. Bullying.

Answer 209

d

Question 210

Which of the following exemplifies the preferred conflict management style of nurse managers?
a. Elizabeth, the head nurse on neurology, finds that Tom, the RN on duty at night, is irritable in relation to any suggestions or new ideas, and so she comes in to work after Tom leaves the unit.
b. The technology committee has recommended a clinical system for implementation on the nursing unit. Staff members are anxious about the change. Stefano, the head nurse, asks staff for ideas on how to meet the technology goals and to meet staff needs.
c. During management meetings, George, the head nurse on the nephrology unit,
dominates meetings and decisions. Lou, the head nurse on the cardiac stepdown
unit, begins to miss the management meetings.
d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The
head nurse, Rajib, agrees as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system.

Answer 210

d

Question 211

Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days to discuss concerns about Jillian’s relationships with her team members. Lee hopes to offer Jillian coaching so that Jillian’s relationships can be more satisfying with her team members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this situation, Lee and Jillian are demonstrating:
a. Similar conflict management strategies.
b. Escalation of conflict.
c. Avoidance and compromise strategies.
d. Competing and compromise strategies.

Answer 211

c

Question 212

Which of the following best exemplifies the accommodation style of conflict management for staff nurses?
a. Leni and Jonas, two RNs, disagree with the best approach to assisting a family that has complex needs. They decide that they will consult with family and together will decide what is best.
b. Jennifer needs to switch a shift to attend a family function. She arranges to trade with Nancy, who wants a day off next to a 3-day break.
c. Alexis asks Melody to stay late for the third day in a row. Melody refuses, stating that she has already helped out for two days by staying late for Alexis.
d. Lara asks Lourdes to switch shifts with her because Lara wants to attend a concert. Lourdes would prefer not to but does to enable Lara, who is new in town, to be with her friends.

Answer 212

d

Question 213

In trying to achieve Magnet status for the hospital, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change, which thus creates organizational conflict. Organizational conflict arises from which of the following?
a. Flat organizational structure.
b. Clarity in role responsibilities.
c. Increased autonomy through self-governance.
d. Less participation in decision-making.

Answer 213

d

Question 214

There are time when avoiding conflict can be effective. Which of the following are appropriate for avoiding conflict? (Select all that apply.)
a. Facing trivial and/or temporary issues.
b. There is no chance to obtain what one wants or needs.
c. Give time for people to “cool down.”
d. To give up forever.

Answer 214

a,b,c

Question 215

The way in which nurses respond to conflict has changed very little in the past 20 years. What are the two most often (based on research) ways nurses use when faced with conflict? (Select all that apply.)
a. Collaborating
b. Avoidance
c. Compromising d. Accommodation

Answer 215

b,d

Question 216

Nurses entering into the workforce today are faced with which of the following relationships that could create organizational conflict? (Select all that apply.)
a. Nurse–physician relationship.
b. Nurse–nurse relationship.
c. Nurse–patient relationship.
d. Nurse–chief nursing officer relationship.
e. Nurse–auxiliary personnel relationships.

Answer 216

a,b,c,,d,e

Question 217

The most important approach that a nurse manager can take with an emotionally troubled employee is to:
a. Act as a therapist for the employee.
b. Adjust the standard of care to assist the employee.
c. Assist the employee in obtaining professional help.
d. Adjust the employee’s work schedule to decrease stress.

Answer 217

c

Question 218

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should:
a. Include a plan to correct them and to prevent future occurrences.
b. State a detailed history of past problems that are related to the current one.
c. Be written at the convenience of the manager.
d. Accumulate until the evaluation period begins.

Answer 218

a

Question 219

Before terminating an employee, a nurse manger must:
a. Be an expert in all legal aspects of employment termination and discipline
practices.
b. Know the organization’s specific policies for addressing disciplinary problems and
employment termination.
c. Function as a counsellor for problem employees.
d. Do everything to assist and protect the employee by adjusting standards and
policies.

Answer 219

b

Question 220

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is to:
a. Provide a verbal reprimand.
b. Prepare a written reprimand.
c. Counsel the employee regarding the problem.
d. Give the employee the day off without pay.

Answer 220

c

Question 221

The chief nursing officer understands that clinical incompetence is best prevented by which of the following?
a. A flexible protocol for evaluating competency skills.
b. A standardized clinical skills checklist.
c. A newly established peer review process.
d. A formalized competency program with established standards for practice.

Answer 221

d

Question 222

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?
a. Use of the performance appraisal on an annual basis.
b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up.
c. A tally sheet of medication errors and other specific problems that will be used at annual review.
d. Copies of reports, placed in the employee’s file, of all unusual occurrences involving the employee.

Answer 222

b

Question 223

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency?
a. The chemically dependent employee usually hides any changes in behaviour.
b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem.
c. The chemically impaired nurse affects the entire health care organization.
d. Hospital policy, state laws, and nurse practice acts address procedures for the
chemically dependent employee in the most general terms.

Answer 223

c

Question 224

The chief nursing officer reviews the policy about “progressive discipline process.” The progressive discipline process includes which of the following?
a. The manager is a counsellor and friend to the employee.
b. The manager should reprimand and suspend the employee as a last resort.
c. The manager should rehire the employee after a reasonable length of time.
d. The manager should terminate the employee if the problem persists.

Answer 224

d

Question 225

A nurse manager must be familiar with the agency’s policies regarding employment termination. Termination procedures include which of the following?
a. Following specific procedures at other organizations.
b. Having an attorney present at the termination meeting.
c. Having adequate written documentation to support the action. d. Having a friend present during the termination meeting.

Answer 225

c

Question 226

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviours are most likely to signal that Nathan is intending to resign from his position on the unit?
a. Increased absenteeism over the past month.
b. Increased attempts to discuss his concerns with his colleagues.
c. Testing of workplace guidelines.
d. Frequent defensiveness.

Answer 226

a

Question 227

All of the following are grounds for immediate dismissal except:
a. Failing to pursue further medical help for a patient, after which the patient dies. b. Selling narcotics obtained from the unit supply of narcotics.
c. Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a
staff member.
d. Grabbing the unit manager and threatening further physical harm after a poor
performance appraisal.

Answer 227

a

Question 228

Nurses generally experience difficulty in identifying behaviours and actions that could signal chemical dependency in a coworker. Which of the following is not a behavioural change that occurs with chemical dependency?
a. Personality and behavioural changes.
b. Job performance changes.
c. Changes in educational involvement and pursuit.
d. Absenteeism.

Answer 228

c

Question 229

Aurora, RN, is a self-admitted drug addict and has abused codeine heavily. Aurora and the unit manager decide that changes have to occur. Aurora enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate?
a. The manager could refer Aurora to the human resources department.
b. The manager could assist in monitoring Aurora’s progress.
c. The manager could counsel Aurora if Aurora has formed a trusting relationship
with her.
d. Aurora needs to be asked not to involve her family in the recovery program
because this is a work-related situation.

Answer 229

b

Question 230

Incivility is a disruptive behaviour or communication that creates negativity in the environment and interferes with quality of patient care and safety. The manager can implement steps that help to alleviate uncivil behaviour on a unit. Which of the following would not be an appropriate first step?
a. Suspending the staff member from work.
b. Providing written admonishment that is discussed and placed in the employee’s
file.
c. Providing verbal admonishment.
d. Terminating the staff member.

Answer 230

d

Question 231

In which order should the strategies below occur in progressive discipline?
a. Suspending the staff member from work.
b. Providing written admonishment that is discussed and placed in the employee’s file. c. Providing verbal admonishment.
d. Terminating the staff member.
a. A, B, C, D
b. B, A, C, D
c. C, B, A, D
d. C, A, B, D

Answer 231

c

Question 232

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, the breaking of rules is so serious that the employee is:
a. Transferred to another unit.
b. Suspended indefinitely.
c. Asked to attend a union grievance meeting.
d. Terminated after the first infraction.

Answer 232

d

Question 233

The nurse manager notices that Tia, a staff nurse, has been absent 2 to 3 days per month for the past 3 months. What is the manager’s best response?
a. “Why are you absent from shifts every month?”
b. “I am concerned that you have been absent 3 days this month.”
c. “Your attendance record is not very good. Do you want to talk about it?”
d. “I am changing your shift rotation as it is obvious that you are not able to
consistently implement your scheduled shifts.”

Answer 233

b

Question 234

Susan, a new graduate, is upset that so many staff members have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that:
a. Not all absenteeism is voluntary.
b. High personal control contributes to absenteeism.
c. Direct discussions with employees who have high levels of absenteeism are not
recommended.
d. All absenteeism is related to personal issues and needs.

Answer 234

a

Question 235

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager’s unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would not be included in the discussion?
a. “As a manager, you need to be aware of professional regulatory reporting requirements.”
b. “As a manager, you should check with the human resources department regarding chemically dependent employees and employment practices.”
c. “As a manager, you check the nurse practice acts for the province in which the nurse resides.”
d. “As a manager, you should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff.”

Answer 235

d

Question 236

The education consultant for the hospital is presenting a workshop on “Documentation: A Manager’s Responsibility.” Which of the following points concerning documentation of personnel problems would she not include in her PowerPoint presentation?
a. “Documentation cannot be left to memory. A notation must be placed in the
personnel file.”
b. “Documentation should avoid discussion of the problem.”
c. “Documentation should include what was done about the problem when it
occurred.”
d. “Documentation needs to include date, time, and place.”

Answer 236

b

Question 237

Although the Health Professions Acts and professional nursing standards and competencies vary across Canada, the underlying expectation is that members of any health care profession recognized in Canada have on overarching mandate to:
a. Maintain competence.
b. Uphold nursing practice standards.
c. Duty to report.
d. Protect the public.

Answer 237

d

Question 238

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah’s peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
a. “It is a nurse’s professional responsibility to maintain quality control.”
b. “All instances of clinical incompetence are to be reported.”
c. “It is not considered being disloyal when one nurse reports another for poor care.”
d. “Patient care is the number one concern. Meeting standards is mandatory and
necessary.”

Answer 238

a,b,c,d

Question 239

Role strain can result in which of the following manifestations? (Select all that apply.)
a. Withdrawal from interaction.
b. Feeling of belonging.
c. Job dissatisfaction.
d. Decreased commitment to the team

Answer 239

a,c,d

Question 240

A nurse’s emotional transference from past trauma may affect their ability to function within a clinical setting. A manager must be attuned to a nurse’s level of emotional well-being. Which of the following could demonstrate a nurse who is exhibiting signs of past trauma? (Select all that apply.)
a. Hostility toward others.
b. Addictive tendencies.
c. Maladaptive perfectionism.
d. Testing of workplace guidelines.

Answer 240

a,b,c,d

Question 241

Many employers have moved from a progressive discipline approach to a nonpunitive approach. The value of this approach is? (Select all that apply.)
a. Enables both parties to attain their dignity.
b. Takes longer to determine an actable outcome.
c. Minimizes ambiguity related role stress.
d. Shifts the responsibility to act from the manager to the employee.

Answer 241

a,b,d

Question 242

Aishwarya is involved in intervening when a patient attempts to harm herself on the unit. During the interaction, the patient slaps Aishwarya across the face. It is important that the head nurse:
a. Offer Aishwarya immediate education and training in self-defence.
b. Assist with follow-up documentation and offer access to counselling.
c. Provide access to a lawyer.
d. Encourage Aishwarya to perceive the incident as a normal part of care.

Answer 242

b

Question 243

Various descriptions of types of violence are available. Which form includes the use of power which differentiates itself from other terms?
a. Horizontal violence.
b. Bullying.
c. Lateral violence.
d. Interpersonal conflict.

Answer 243

b

Question 244

According to the Government of Ontario, Ministry of Labour health care report (2017), workplace violence “accounted for what percentage for all lost-time injuries in the health care sector?
a. 10%
b. 20% c. 12% d. 5%

Answer 244

c

Question 245

Your health care organization places a high value on workplace safety and integrates this into all aspects of administrative and patient care processes. As a unit manager, you thoroughly endorse this direction, and during the selection and hiring of new staff, you consistently:
a. Refuse to hire applicants who are pushy during interviews.
b. Thoroughly follow up with all references before offering a position.
c. Ask applicants during the interview whether drug or alcohol abuse is a problem.
d. Refuse to interview applicants with sporadic work histories.

Answer 245

b

Question 246

Jay, a newly graduated registered nurse (RN), has just begun work on an acute care nursing unit. As a nurse manager, you know that new graduates are most likely to experience:
a. Aggression.
b. Horizontal violence.
c. Physical violence.
d. Vertical violence.

Answer 246

b

Question 247

In which of the following situations would you, as the head nurse, be concerned about potential safety issues?
a. Jordan comes to your office to complain about inadequate staffing on the unit. He
says that he is concerned because he attributes a recent incident to the staffing
levels.
b. Heinrich, a long-standing RN on the unit, has begun to miss work regularly. He
calls in but is vague about his reasons for the absences.
c. Carla, RN, has just ended a relationship with Jake, RN, and he will not leave her
alone. You are meeting with Jake today because colleagues on night shifts have
reported that Jake seems to have been intoxicated last night and the previous night.
d. Sarah is very quiet and says almost nothing in team meetings. Lately, she has been
much more animated since becoming friendly with a couple of other RNs on the unit

Answer 247

c

Question 248

Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively telling others that you are incompetent, you do not know what you are doing in relation to patient care, and that you lie to the staff about attempts to get more staffing. Through telephone calls and conversations during breaks, she is recruiting other staff to her position. Delaney confides that most staff members find you fair, honest, and knowledgeable. Marjorie’s behaviour can best be characterized as:
a. Political action.
b. Bullying.
c. Building alliances.
d. Disgruntlement.

Answer 248

b

Question 249

During coffee and other breaks, Rosalie, the new RN, is excluded from conversations with the other staff. When she approaches other staff on the unit to ask questions, they turn and walk off in the other direction. The behaviour of the staff is characteristic of:
a. Dislike.
b. Lack of trust in Rosalie’s abilities.
c. Horizontal violence.
d. Cultural incompetence.

Answer 249

c

Question 250

Sabotage is an example of which type of violence?
a. Threatening behaviour.
b. Written threat.
c. Harassment.
d. Verbal abuse.

Answer 250

c

Question 251

Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car accident. The father screams at her and tells her that she has no right to ask his family to leave, and that if she continues to do so, he will “throw her out of the room.” Caroline is shaken and tells her head nurse, who tells her that this kind of thing is just part of the job. The guidance of the head nurse:
a. Is reasonable. No physical violence was involved.
b. Is related to why incidents of violence in health care are probably underreported.
c. Acknowledges the deep distress and fear of the family.
d. Acknowledges the concern of the nurse.

Answer 251

b

Question 252

You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your health care organization. This team has been established in response to increases in reports of violence and aggression. You begin designing the safety plan by:
a. Surveying staff about levels of satisfaction with the workplace and management,
collegial, and patient relations.
b. Offering training sessions in self-defence.
c. Developing a policy that outlines zero tolerance for bullying.
d. Offering education sessions on recognizing behaviours with potential for violence.

Answer 252

a

Question 253

In the emergency department waiting room, you notice a patient sitting, with his head in his hands, who has been waiting for about 5 hours for relief of his headache. When you approach him to ask him how he is doing, he says, “I can’t believe that I have to wait this long for help! Do you know what it is like to be in pain for 10 hours?” Your response to him would be:
a. “It is frustrating to wait when you are in pain and when you are expecting to receive relief right away.”
b. “Don’t talk to me. If you are going to be rude, then you will not receive treatment
here.”
c. “We are very busy and don’t have enough staff to deal with problems such as
yours.”
d. “Perhaps you should go elsewhere. We do not have time for you here, as many
more sick patients are waiting.”

Answer 253

a

Question 254

At 3 a.m., a man walks into your emergency department. He paces back and forth in the waiting area before he approaches staff to ask if he can see his wife, who is a patient on another floor. He speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his jacket pocket. A best initial response would be to:
a. Assess your situation and your surroundings.
b. Ask two or three staff to assist in confronting the individual.
c. Ask what floor his wife is on and remind him that visiting hours are over.
d. Remain calm as there is no potential for violence here.

Answer 254

a

Question 255

The Canadian Nurses Association (CNA) cites studies that suggest that intimidating and disruptive behaviours in the nursing profession contribute to:
a. Low morale.
b. Preventable adverse outcomes.
c. An increase in power for leaders.
d. Citations of leaders for not addressing workplace violence.

Answer 255

b

Question 256

Residents in a new long-term care facility attend meals in a large dining hall. In reviewing reports of aggression and violence, you note that behaviours such as hitting or attempts to hit staff are increasing. Further investigation suggests that this behaviour occurs most often at mealtimes. A possible intervention would be to:
a. Seat residents with the highest potential for violence next to those with the lowest potential for aggression.
b. Feed residents earlier in the day.
c. Restrain residents who are violent or aggressive during meal times.
d. Establish a smaller dining area that is away from the main area that is for residents
who have potential for aggression/violence.

Answer 256

d

Question 257

Many inaccurately believe workplace violence to be related specifically to:
a. Verbal abuse.
b. Physical injury.
c. Incivility.
d. Harassment.

Answer 257

b

Question 258

As indicated by Shield and Wilkins for Statistics Canada (2014), abuse in the health care setting is most often perpetrated by someone who:
a. Is male.
b. Has more experience.
c. Consistently works day shifts.
d. Has high coworker support.

Answer 258

a

Question 259

In addressing a high staff turnover rate that results from violence on a nursing unit, you are: a. Confirming the high correlation between managerial incompetence and violence.
b. Demonstrating awareness that workplace violence, if present, has significant costs.
c. Aware that staff and manager experiences contribute to high turnover.
d. Aware that violence is a rare but present factor in the workplace.

Answer 259

b

Question 260

A patient who has a history of involvement with drugs and weapons comes up to you in the hallway and asks you a question regarding directions in treatment. When you respond, he moves closer in to you and puts both hands up on either side of your neck. No one else is in the hallway. Your best response at this point is to:
a. Yell at him to stop.
b. Calmly ask the patient to remove his hands.
c. Hit the patient in the midsection.
d. Use pepper spray.

Answer 260

b

Question 261

Canadian knowledge of the scale of workplace violence in health care remains incomplete because:
a. Collected data are inflated.
b. No consistent system of data collection for workplace violence exists.
c. Data is collected only in relation to physical injuries.
d. The classification of workplace violence is unclear.

Answer 261

b

Question 262

Reza, RN, works as a staff nurse in the mental health department; Sharon works as a data entry clerk in the admissions department; Sarah is an emergency room physician; and Donna is a housekeeper in the geriatrics department. Which of these four is most at risk for violence: and aggression?
a. Reza. b. Sarah. c. Sharon. d. Donna.

Answer 262

a

Question 263

Reza, RN, works as a staff nurse in the mental health department; Sharon works as a data entry clerk in the admissions department; Sarah is an emergency room physician; and Donna is a housekeeper in the geriatrics department. Which of the four is most likely to be a perpetrator of violence?
a. Reza. b. Sarah. c. Sharon. d. Donna.

Answer 263

a

Question 264

A safety and security plan is important to a health care organization because it: a. Specifies preventive measures in relation to violence.
b. Provides direction as to changes in facilities that protect staff.
c. Establishes expectations in relation to behaviour and tolerance of violence. d. Establishes policies and practices that guide prevention of violence and
expectations in the workplace.

Answer 264

d

Question 265

Aishwarya is involved in intervening when a patient attempts to harm herself on the unit. During the interaction, the patient slaps Aishwarya across the face. It is important that the head nurse:
a. Offer Aishwarya immediate education and training in self-defence.
b. Assist with follow-up documentation and offer access to counselling.
c. Provide access to a lawyer.
d. Encourage Aishwarya to perceive the incident as a normal part of care.

Answer 265

b

Question 266

A poll conducted by the Canadian Federation of Nurses Unions (CFNU) there were 16, 617 claims between the years 2006–2015. This is over double the rate reported by police and correctional service officers in the same time period. The two most often reported incidences of violence are? (Select all that apply.)
a. Verbal by physician.
b. Verbal by patient.
c. Verbal by nurse colleague.
d. Verbal by family member.

Answer 266

b,c

Question 267

Many theories exist as to why horizontal violence takes place in nursing. Which of the following are thought to be contributing factors to violence in nursing? (Select all that apply.)
a. Worker burnout.
b. Hierarchical structure.
c. Feminism.
d. Lack of supports.

Answer 267

a,b,c,d

Question 268

In designing a new health care facility, it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings? (Select all that apply.)
a. Emergency.
b. Psychiatry.
c. Gerontology.
d. Maternity-pediatric.

Answer 268

a,b,c

Question 269

The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with patients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of:
a. Acceptance.
b. Negotiation.
c. Discrepancy. d. Internalization.

Answer 269

c

Question 270

An interviewee for a nurse manager position asks for a copy of the organizational chart. Organizational charts provide information about the role component of:
a. Expectations.
b. Opportunities.
c. Responsibilities.
d. Lines of communication.

Answer 270

d

Question 271

Sue, a newly graduated registered nurse, has been on the orthopedic unit for about 6 months and is reconciling discrepancies between what she thought her role was in relation to peer performance appraisal and what it actually is. This is an example of role:
a. Discrepancy.
b. Ambiguity. c. Integration. d. Stabilization.

Answer 271

c

Question 272

The head nurse and the administrator of a cardiac telemetry unit disagree on how much time the head nurse should allot to various aspects of the role. Staff members on the unit complain that the head nurse is unavailable for clinical concerns because of being off the unit while attending meetings. To facilitate the process of role transition, the head nurse should:
a. Rely on his or her internal resources.
b. Attend a workshop on how to deal with difficult people.
c. Develop a relationship with a mentor who has overcome similar difficulties.
d. Schedule a series of meetings with staff and the administrator to clarify
expectations.

Answer 272

d

Question 273

The new nurse manager feels torn by the expectations of staff, the demands of hospital administrators, and family obligations. According to Hardy (1978), unrelieved role stress and strain will lead to:
a. Frustration and anger.
b. Alienation of family and friends.
c. Low productivity and performance.
d. Physical symptoms and acute illness.

Answer 273

c

Question 274

The nurse manager of a unit was demoted to staff nurse 6 months ago. Because of being near retirement, the former nurse manager wanted to be employed at the hospital and was offered a position on the same unit. The former nurse manager complains often about how infrequently the current nurse manager is available on the unit and argues with physicians and coworkers. Patients have complained about the attitude of the former nurse manager. The behaviour of the former nurse manager can be best explained as being caused by:
a. Overwork in the staff nurse position.
b. Inadequate mentoring in the new role.
c. Anger as a stage of the grieving process.
d. Demotion as a threat to personal identity.

Answer 274

c

Question 275

A nurse is interviewing for a manager’s position. Which of the following actions is considered a role preview?
a. Formal commitment of the employment contract.
b. Improving role performance.
c. Touring the unit.
d. Disillusionment about the expectations of the job.q

Answer 275

c

Question 276

The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs. The main purpose of mentoring is:
a. Promoting staff retention.
b. Promoting staff attrition.
c. Developing new role expectations.
d. Promoting staff supervision.

Answer 276

a

Question 277

A nurse manager notices that Nathan, a registered nurse (RN) who has been on the unit for approximately 3 years, has a particular interest in technology and seems to be very enthusiastic about working with software and hardware at home. She speaks with Nathan and asks him if he would lead an investigation of software applications on the unit. This is an example of:
a. Opportunity.
b. Delegation.
c. Role negotiation.
d. Role transition.

Answer 277

a

Question 278

After beginning her new position, Samia spends a great deal of time in direct patient care. Her staff begin to complain that they are never able to find her when they need her and that some aspects of her responsibilities fall behind, such as scheduling. Samia is probably:
a. Lacking an understanding of the nurse management role.
b. Attempting to prove her clinical skills to the nursing staff.
c. Experiencing difficulty in unlearning old roles.
d. Lacking enjoyment in her new role.

Answer 278

c

Question 279

A strategy that may help Samia make the transition to her management role and to respond to relationships and situations in her new position is:
a. Avoiding discussion of her personal beliefs with staff until she is ready to do so.
b. Finding a network of clinicians with similar interests to her own.
c. Researching clinical literature to maintain her clinical assessment skills for the unit.
d. Recognizing her strong commitment to care in the management process through journalling.

Answer 279

d

Question 280

Samia finds a mentor, Amy, who has been in the role of unit manager for 3 years and has a similar interest in clinical excellence. During their frequent meetings, Amy provides assistance with learning aspects of the manager’s role, including technical aspects, such as how to interpret budget printouts and to achieve budget outcomes. The success of Amy’s coaching depends on:
a. Clarity of Amy’s information.
b. Organizational support for the mentor relationship.
c. The congruence of Amy’s beliefs with Samia’s beliefs. d. Willingness of Samia to receive feedback.

Answer 280

d

Question 281

In addition to providing coaching, a nurse mentor may provide counselling to the mentee. For counselling to be successful, the mentor must:
a. Provide a quiet environment away from the unit.
b. Keep the focus on technical and management responsibilities.
c. Ensure confidentiality.
d. Present assignments that stretch the intellectual and technical ability of the mentee.

Answer 281

c

Question 282

According to Duchscher (2011), the integration phase in the transition to a new professional
role for the new nursing graduate includes actions such as:
a. Performing and learning.
b. Separating and exploring.
c. Adjusting and accommodating.
d. Doubting and revealing.

Answer 282

d

Question 283

Samia (questions 11 to 15) finds that she is comfortable with the expectations of staff and her supervisor with regard to her management role and responsibilities, and has been able to effect a strong commitment to quality clinical care on the unit. At this point, Samia has probably attained role:
a. Development. b. Acceptance. c. Symmetry.
d. Stabilization.q

Answer 283

d

Question 284

As a nurse manager, you have hired two new graduates for your unit. To assist the new graduates in their role transition from student to practicing RN, you advocate for:
a. A journalling program.
b. Hiring a nurse educator to work with these and other new graduates.
c. Additional time off for nurses to practice RN skills.

Answer 284

b

Question 285

Oscar, a new nurse manager, complains to his colleague that he feels very uncomfortable with the conflict between what he thinks he should be doing as the manager and what his supervisor thinks he should be doing. According to Hardy’s (1978) role theory, Oscar is experiencing:
a. Stress.
b. Role stress.
c. Role strain.
d. Role exploration.

Answer 285

c

Question 286

Seth is hired as the nurse manager for a surgical unit. After a year the hospital reorganizes, and his position is lost. In leaving the unit, it is important for Seth to:
a. Engage in clarifying why the hospital did not state its expectations for the unit at the time of hiring.
b. Hire a lawyer to represent his interests during this unexpected role transition.
c. Seek counselling to deal with his shock and anger.
d. Negotiate a reasonable settlement.

Answer 286

d

Question 287

After several months in the role of manager of a dialysis unit, Maryanne finds herself still questioning the gap between her and her staff’s expectations and management’s expectations, and is also questioning whether she can reconcile her concerns with quality care with the strong cost-containment orientation of the facility. At this point, Maryanne is in which stage of role transition?
a. Internalization. b. Acceptance.
c. Development. d. Discrepancy.

Answer 287

d

Question 288

In assisting new graduates to make the role transition to graduate nurse, Teo, the unit manager, initiates which of the following?
a. Self-checklist to assess competencies that have been strengthened.
b. Discussions that focus on what the new graduates have yet to learn.
c. Fixed target dates for acquisition of competency and transition to RN role.
d. Frequent formal meetings to provide feedback on performance and areas to be
strengthened.

Answer 288

a

Question 289

Who of the following might be the best mentor for Kira, a new nurse manager on the cardiac unit who has 4 years of previous clinical experience?
a. Saul, near retirement. He has 20 years of clinical nursing and recently assumed
role of head nurse in an interim capacity because of the incumbent’s illness.
b. Leilani, who has been a clinical educator at the institution for a number of years.
She has tired of her role and aspires to become a nurse manager. She looks at
mentorship as an opportunity to understand the role better.
c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor
value her skills, her leadership acumen, and her championship of innovation.
d. Adrian, who was nurse manager for 3 years, soon after graduation. He left the role because he was uncomfortable with the expectations and has been a team leader in
the surgery unit for 15 years.

Answer 289

c

Question 290

ROLES represents an acronym to help guide and retain information. Which of the following is not a part of ROLES?
a. Responsibilities.
b. Opportunities.
c. Lines of communication.
d. Expertise.
e. Support.

Answer 290

d

Question 291

As a result of Amy’s coaching, Samia (question 16) completes an assessment of responsibilities, opportunities, lines of communication, expectations, and support (ROLES). This assessment is helpful in: (Select all that apply.)
a. Identifying her clinical knowledge.
b. Role development.
c. Areas of conflict in expectations. d. Management responsibilities.

Answer 291

b,c,d

Question 292

Preceptorship is distinguished from mentorship by? (Select all that apply.)
a. Shorter tenure.
b. Differing supporter characteristics.
c. Risk taking and creativity.
d. Narrower objectives.

Answer 292

a,b,d

Question 293

Preceptorship is “a period of practical experience and training for a trainee supervised by an expert or specialist in a particular field” (The Ottawa Hospital, n.d.). Preceptorships is seen as? (Select all that apply.)
a. Used in the context of a student completing a clinical practicum.
b. A focus on the learning of tasks, skills, and routines.
c. An efficient and effective way to introduce an individual to a new role.
d. Grounded in advanced relational capacity and expertise.

Answer 293

a,b,c

Question 294

Nursing professionals in the twenty-first century will accomplish most of their work:
a. Through teams of internationally prepared professionals.
b. In teams and through group work.
c. Through long-term, secure jobs.
d. In competitive environments and work groups.

Answer 294

b

Question 295

Which of the following actions is most representative of how health care of the future might be delivered? As a nurse leader, you:
a. Refer families who require immediate help to a local food bank. You also work
with local agencies and families to establish a mothers’ collective in which mothers learn about nutrition and prepare low-cost, nutritious meals that are shared with the mothers in the collective.
b. Work together with a local agency to set up a free clinic in which addicts and the homeless can receive free health care and prescriptions for immediate needs.
c. Ensure that individuals who are admitted to your unit are asked about their smoking history and that preoperative and postoperative planning takes into account how smoking will affect status during and after surgery.
d. Address the health of patients who are overweight and obese on your unit by ensuring that hospital meals offer nutritious, healthy food choices that are satisfying.

Answer 295

a

Question 296

A local nurse is responsible for developing a new service. She spends many hours contacting the presidents of three community groups, and she works with the neighbourhood association. This effort reflects which of the leadership strengths proposed by Lipman-Blumen (2000)?
a. Ethical political savvy.
b. Authenticity and accountability.
c. Politics of commonalities.
d. Leadership through expectation.

Answer 296

c

Question 297

After working for a nurse manager for the past 8 months, a staff nurse notices that many decisions made by the nurse manager benefit the manager more than the staff members. Which leadership quality is this nurse manager lacking?
a. Ethical political savvy.
b. Authenticity and accountability.
c. Leadership through expectation.
d. Quest for meaning.

Answer 297

b

Question 298

The chief nursing officer has been developing her portfolio for years. She has been modelling:
a. Her clinical expertise.
b. Memories of different colleagues.
c. Her ability to be employable.
d. Her busy professional life.

Answer 298

c

Question 299

It is important for a nurse manager to become a “future thinker.” Which is an example of a “future thinker”?
a. Keeping traditional practices.
b. Moving toward evidence-informed practices.
c. Finding less need for more knowledge.
d. Believing that macromarketing will be a necessity.

Answer 299

b

Question 300

Nursing research has indicated that the foundation for becoming a nursing leader is the ability to:
a. Write effectively.
b. Speak two or three languages.
c. Have a dialogue with others.
d. Think critically.

Answer 300

d

Question 301

Which of the following behaviours exemplifies the characteristic most desired in the nurse of the future?
a. Coordination and maximization of resources.
b. Acquiescence to the leader.
c. Attentiveness to detail.
d. Development of vision that is based on current realities, future trends, and
evidence.

Answer 301

d

Question 302

Health care demographics, changing funding levels, and alternative approaches to care all interact with and influence one another. Nursing at individual, unit, and systems levels influences health care and society, and vice versa. The implication of this is that:
a. Funding levels will reduce the number of nursing positions.
b. The ethical influence of nursing on political decisions increases public trust in nursing.
c. Negative publicity by politicians will negatively affect public perceptions of nursing.
d. The public has little effect on the organization of health care.

Answer 302

b

Question 303

The starfish analogy is exemplified in which of the following?
a. A unit manager resigns after continued tension between herself and the
administration regarding implementation of primary nursing. The primary nursing
project dies.
b. Nurses try to establish a clinic that provides ambulatory care to parents and young
children in an impoverished neighbourhood. Community members advocate for
funding of the clinic by political leaders and insurers.
c. Alana, a new graduate, promotes continence care that is informed by evidence.
When she presents her ideas, senior staff refuse to consider it.
d. The head of a community health service moves on to another position. Programs in
the health service are disbanded.

Answer 303

b

Question 304

Which of the following hampers the ability of nurses to be leaders?
a. A focus on the patient and not on the system.
b. Lack of interest in leadership.
c. Disillusionment with change.
d. Funding disparities.

Answer 304

a

Question 305

Which of the following strategies is most important in developing a strong vision?
a. Seeking out evidence to support trends and innovative thinking.
b. Spending time with others to discuss ideas.
c. Setting up focus groups to provide information on current realities.
d. Being honest and open about what the person thinks for the future.

Answer 305

d

Question 306

To move beyond stereotypical thinking and toward thinking about the future, which of the following would be most helpful?
a. Listing everything that is known about the current situation.
b. Defining which practices will remain unchanged and which will change.
c. Asking someone with a great deal of experience to share ideas about best practice.
d. Challenging current and future practices with questions of “What if…?”

Answer 306

d

Question 307

The Canadian Nurses Association`s vision for 2020 includes:
a. Focusing the delivery system on health care providers.
b. Rapidly accelerating the adoption of promising technologies.
c. Concentrating the delivery of health care on institutions.

Answer 307

b

Question 308

A stroke unit undergoes numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. This exemplifies:
a. A poor relationship between leaders and staff.
b. Lack of knowledge regarding the importance of changes.
c. Striving to achieve stability in the midst of great disequilibrium.
d. The importance of chaos in promoting adherence to established practices.

Answer 308

c

Question 309

The leadership style that promotes and facilitates change that is important for realizing a future vision is:
a. Autocratic.
b. Relational.
c. Paternalistic.
d. Task oriented.

Answer 309

b

Question 310

Jadzia is a school nurse in a large urban high school. She observes the numbers of students smoking and understands the usefulness of increased evidence of acute and chronic disorders related to smoking. After involving teachers, parents, students, and the community, she implements a smoking cessation program. Her program reflects which strength of connected leadership?
a. Quest for meaning.
b. Authenticity and accountability.
c. Thinking for the long term, acting for the short term.
d. Leadership through expectation.

Answer 310

c

Question 311

Omar works with adolescents in an addictions clinic and has a staff of two RNs. The clinic has been extraordinarily successful because of Omar’s ability to inspire staff and to inspire adolescent patients to achieve success. What connected leadership strength is Omar displaying?
a. Authenticity and accountability.
b. Quest for meaning.
c. Ethical political savvy.
d. Leadership through expectation.

Answer 311

d

Question 312

A necessary leadership strength for nurses of the future is:
a. The ability to involve health care teams in common interests to achieve outcomes
that meet their needs.
b. Enhanced skills and knowledge in advanced clinical techniques.
c. Understanding of the nuances of fundraising to make up funding shortfalls. d. The ability to manage a workforce that lacks loyalty to one organization.

Answer 312

a

Question 313

Marco tells you that he has selected nursing as a career because many jobs are available and he will have job security. Your best response to Marco is:
a. “With many young people going overseas, many jobs and options will be
available. Stable jobs and job security will be part of the nursing employment
market.”
b. “The job market for nurses will be diminished with funding cuts to hospitals.”
c. “The employment prospects for nurses are positive with many options to choose
from. Flexibility and adaptability are essential to income security.”

Answer 313

c

Question 314

This term refers to the intensity of increasing functions and expectations without a change in resources, including time.
a. Individual visioning.
b. Chaos.
c. Complexity compression.
d. Shared visioning.

Answer 314

c

Question 315

In developing curricula that will address needs on the basis of forecasts for the future, nursing educators need to contemplate: (Select all that apply.)
a. Population-based strategies to prevent chronic disorders.
b. Leadership skills and knowledge.
c. Competence in use and application of technology.

Answer 315

a,b,c

Question 316

Future nurse leaders can be fostered by creating a space for career curiosity. Which of the following are traits of career curiosity? (Select all that apply.)
a. Embracing learning.
b. Promoting new ideas.
c. Being inquisitive

Answer 316

a,b,c

Question 317

The National Expert Commission was established by the Canadian Nurses Association (2012) to identify ways to meet the future health needs of Canadians. Key priorities for healthcare transformation include? (Select all that apply.)
a. Focusing on primary health care for all.
b. Addressing the social determinants of health.
c. Addressing needs of vulnerable and marginalized people and communities.
d. Integrating health in all policies; ensure safe and quality care.

Answer 317

a,b,c,d

Question 318

A new graduate is seeking a new position in nursing and wants to “sell” herself effectively. The best strategy is to:
a. Create a résumé.
b. Practise interviewing.
c. Call the personnel offices.
d. Create a curriculum vitae (CV).

Answer 318

a

Question 319

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse has to update her résumé to include her teaching experience. The goal of creating a CV is to:
a. Have a listing of facts about your professional life.
b. Create an opportunity to be interviewed.
c. Respond quickly whenever a position becomes available.
d. Be certain that you can recall facts for a prospective position.

Answer 319

b

Question 320

To develop a CV or résumé, a nurse should begin with:
a. Creating an opportunity to be interviewed.
b. Listing facts about his or her professional life.
c. Hiring someone to market himself or herself.
d. Identifying his or her name and contact information.

Answer 320

b

Question 321

Knowing your professional strengths is important to:
a. Find your fit in positions and a career path.
b. Maintain a professional status.
c. Act in a manner that is legal and ethical.
d. Understand the role expectations of a position.

Answer 321

a

Question 322

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path?
a. You are pressured to do so by your supervisor.
b. The organization has no other suitable candidate for the position.
c. You have limited knowledge of information technology and no real interest, but
this will increase your knowledge.
d. Accepting a position outside of your established skill set may establish you
organizationally as an innovative, adaptable leader.

Answer 322

d

Question 323

Your vision is your dream for your career. Who do you wish to be as a nurse? To achieve this vision you need to visualize steps to help you reach your desired path. Which of the following will help you achieve your vision?
a. Take advantage of an opportunity.
b. Select specific courses that support your vision.
c. Seek faculty with similar interest to your nursing career.
d. All of the options.

Answer 323

d

Question 324

Emily has completed an environmental scan. She is interested in being a nurse specialist in geriatrics particularly in dementia and Alzheimer care. Which of the findings in the environmental scan would most assist Emily in successfully fulfilling this vision?
a. The elder population is growing.
b. Long-term care facilities need more nurses.
c. Many nurses do not prefer to work in long-term care.
d. Dementia and Alzheimer disease in the elderly population continues to rise.

Answer 324

d

Question 325

What is essential for student nurses to achieve under the Career Planning Model? (Select all that apply.)
a. To develop the skill and capacity to lead and manage their own career.
b. To foster each student’s ability to shape their engagement in their nursing
education to achieve their unique career goals.
c. To find the best job possible.
d. To approach their learning with intention and personal commitment.

Answer 325

a,b,d

Question 326

The number of career options for nurses has increased dramatically. Which of the following are a potential opportunity for a nursing career? (Select all that apply.)
a. Working with philanthropic organizations.
b. Working as a pharmaceutical company representative.
c. Taking on a political role.
d. Providing counselling.

Answer 326

a,b,c,d

Question 327

Activities that contribute to pursuing and developing a rewarding nursing career include? (Select all that apply.)
a. Travelling.
b. Education.
c. Volunteer work. d. Work experience.

Answer 327

b,c,d

Question 328

Regardless of the stage one may be at in their career, career planning is a continuous process of? (Select all that apply.)
a. Moving from job to job.
b. Visioning.
c. Goal-setting.
d. Self-assessment.

Answer 328

b,c,d

Question 329

You demonstrate leadership when you? (Select all that apply.)
a. Volunteer.
b. Join committees.
c. Seek student membership.
d. Attend class.

Answer 329

a,b,c

Question 330

Management in relation to your career requires which of the following? (Select all that apply.)
a. Setting goals.
b. Waiting for the right time.
c. Taking action with your career vision.
d. Engaging in activities to achieve career vision.

Answer 330

a,c,d

Question 331

Career planning and development is a process. Which of the following are critical aspects of career planning? (Select all that apply.)
a. Creating a career vision.
b. Assess strengths and limitations.
c. Develop a plan.
d. Visit your plan monthly.

Answer 331

a,b,c

Question 332

A self-assessment is about looking inside yourself. You would not consider developing a care plan without a thorough assessment, and so it does not make sense to develop your own career plan without a thorough self-assessment. Reflect on the question, “Who am I?” What information would be included in this phase? (Select all that apply.)
a. Professional and personal values.
b. Knowledge.
c. Skills.
d. Achievements.

Answer 332

a,b,c,d

Question 333

An environmental scan is about looking outside yourself and into the world. What aspects would you include in an environmental scan? (Select all that apply.)
a. School.
b. Local.
c. National. d. Global.

Answer 333

a,b,c,d

Question 334

A strategic career plan is a blueprint for action. Similar to a care plan, it consists of the identification of goals, action steps, resources, timelines, and evaluation of success. What are the critical aspects of planning? (Select all that apply.)
a. Action steps.
b. Resources.
c. Reality check.
d. Career goals.

Answer 334

a,b,d

Question 335

Waddell et al. (2009) reported that the curriculum-based CPD intervention continued to have a positive impact on intervention participants 12 months postgraduation who reported attitudes and behaviours consistent with ongoing career resilience. Which of the findings apply? (Select all that apply.)
a. Able to adapt to ever-changing workplaces.
b. Able engage in self-directed opportunities for professional growth.
c. Able to seek external support.
d. Able to respond positively to their work environments.

Answer 335

a,b,d

Question 336

John is part of an interdisciplinary care team on a surgical unit. Interdisciplinary care teams:
a. Increase fragmentation of care.
b. Improve quality of patient care.
c. Increase duplication of services.
d. Need to include licenced and unregulated care providers.

Answer 336

b

Question 337

A key advantage that a nurse manager has in terms of delegating is that:
a. Patients receive less attention because too many staff members make it difficult to
coordinate care.
b. Nurses report less pressure to perform necessary tasks themselves. c. Administration can predict overtime more accurately.
d. Team skills can be used more effectively.

Answer 337

d

Question 338

The nurse on the shift from 2300 to 700 hours is assigning a component of care to an unregulated care provider. The night nurse should remain:
a. Accountable and responsible.
b. Accountable and liable.
c. Authoritative and liable.
d. Responsible and task oriented.

Answer 338

a

Question 339

uring a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on:
a. Supportive behaviour by the leader and immature followers.
b. The relationship with the followers and the type of behaviour of the leader.
c. Well-trained followers, combined with a strong leader who acts quickly.
d. The leader’s ability to evaluate personnel and communicate that evaluation.

Answer 339

b

Question 340

The unit manager is working in a large metropolitan facility and is told that two unregulated care providers are to be assigned to work with her. Delegation begins with:
a. Acknowledging the arrival of the second unregulated care provider on the unit.
b. Providing clear directions to both unregulated care providers.
c. Matching tasks with qualified persons.
d. Receiving reports from the prior shift.

Answer 340

c

Question 341

Although interdisciplinary health care teams are the ideal in Canada, which of the following is an identified barrier to interdisciplinary collaboration?
a. Power equalities.
b. Overlapping scopes of practice.
c. Lack of legislative authority.
d. Lack of professional association support.

Answer 341

b

Question 342

Who is accountable when a registered nurse performs a “transfer of function” from a physician activity?
a. The physician.
b. The director of nursing.
c. The nurse.
d. The institution.

Answer 342

c

Question 343

In some provinces, a restricted activities or controlled acts model is currently in place. A main distinction between this model and the model of licensure that is still used in most other provinces is that:
a. Each health care provider is registered to conduct specific tasks.
b. Specific acts are licenced.
c. Acts cannot be shared among health care providers unless they are registered.
d. Nurses are bound by exclusive scopes of practice.

Answer 343

b

Question 344

Which of the following is a benefit of the controlled acts model over the licensure model?
a. Decreased flexibility in allowing patients choice in their care provider.
b. Limited range of professional responsibility.
c. No firm boundaries.
d. Recognition that scope of practice is static.

Answer 344

c

Question 345

Although benefits of the controlled acts model are advantageous and arguably necessary, the legislative reform to recognize overlapping competencies has caused:
a. Role clarity.
b. A decrease in “turf” competition among health care providers.
c. A difficulty in optimizing skill mix.
d. Static boundaries for health care providers.

Answer 345

c

Question 346

Which of the following is a domain of the National Interprofessional Competency Framework?
a. Quality improvement.
b. Interprofessional conflict resolution.
c. Contextual issues.
d. Interdisciplinary communication.

Answer 346

b

Question 347

According to the National Interprofessional Competency Framework, which domain is considered relevant in every situation?
a. Role clarification.
b. Team functioning.
c. Patient-centred care.
d. Collaborative leadership.

Answer 347

c

Question 348

Which of the following is considered a system-relevant barrier to primary care and public health collaboration?
a. Lack of common agenda.
b. Power and control issues.
c. Resource limitations.
d. Relationship challenges

Answer 348

b

Question 349

Which of the following is considered an organizational facilitator to primary care and public health collaboration?
a. Shared protocols.
b. Role clarity.
c. Education and training.
d. Philosophy and personal identity.

Answer 349

a

Question 350

Sammi, a registered nurse, is part of an interdisciplinary team that provides care to patients with acute cardiac interferences. The team has not been functioning optimally and Sammi is aware that this may cause a(n):
a. Increase in the cohesiveness of the team.
b. Escalation of turf protection.
c. Increase in the quality of patient care.
d. Decrease in workplace stress.

Answer 350

b

Question 351

When there is lack of role clarity within an interdisciplinary health care team, health care providers tend to:
a. Work more closely together for role clarity.
b. Move away from their own disciplinary silos.
c. Revert to what is familiar and what they know in relation to health care roles.
d. Increase communication to enable a sharing of role expectations.

Answer 351

c

Question 352

When there is lack of role clarity, health care providers tend to remain in their own disciplinary silos. Which of the following would counteract this tendency?
a. Rearranging team membership.
b. Assigning a team leader.
c. Engaging licencing organizations to increase scope of practice details.
d. Practising patient-centred care.

Answer 352

d

Question 353

In transferring a patient, Leslie, an unregulated care provider, uses improper technique. The patient is injured, and as a result a lawsuit is launched in which both Neha, the delegator, and Leslie, the delegatee, are named. Neha is named in the suit because she:
a. Retains responsibility for the care of the patient.
b. Worked the same shift as Leslie.
c. Has passive accountability for delegation.
d. Retains accountability for the outcomes of care for the patient.

Answer 353

d

Question 354

One strategy to facilitate clarity about team members and the team process is to:
a. Ensure a range of personality styles on the team.
b. Establish colocation of the team.
c. Appoint a physician as the team leader.
d. Engage a variety of health care providers on the team with different levels of power.

Answer 354

b

Question 355

The rationale for the shift to interdisciplinary teams for health care delivery in Canada is related to: (Select all that apply.)
a. The aging of the population.
b. Increased utilization of unregulated care providers.
c. Nurse shortages.
d. An increase in acute illness and comorbidity.
e. Increasing specialization of health care providers.

Answer 355

a,c,d

Question 356

Barriers to initiating interprofessional collaboration are many. Which of the following apply? (Select all that apply.)
a. Practice protection.
b. Regulatory mechanisms.
c. The concept is well accepted.
d. Outdated legislation.

Answer 356

a,b,d

Question 357

What is an intraprofessional team is composed of? (Select all that apply.)
a. A mix of same discipline with different levels of education.
b. Members of same discipline.
c. Members of different disciplines.
d. Members of different disciplines with extended levels of education.

Answer 357

a,b